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Navigating Infective Native Aortic Aneurysms in Tropical Regions: Insights from a Five-Year Malaysian Experience

Karthigesu Aimanan1, Movin Yeoh1, Michael Arvind1

  • 1Department of Surgery, Hospital Kuala Lumpur, Kuala Lumpur, Malaysia.

Annals of Vascular Surgery
|July 10, 2025
PubMed
Abstract

Insights

Infective native aortic aneurysms (INAAs) management requires tailored surgical or endovascular repair. Outcomes are favorable with appropriate antibiotic therapy and multidisciplinary care, even with challenging pathogens like Burkholderia pseudomallei.

Area of Science:

  • Vascular Surgery
  • Infectious Diseases
  • Aortic Aneurysm Management

Background:

  • Infective native aortic aneurysms (INAAs) present unique challenges in diagnosis and treatment.
  • Understanding clinical characteristics and microbiological profiles is crucial for effective management.

Purpose of the Study:

  • To describe the clinical features, microbiology, treatment strategies, and outcomes of INAAs.
  • To evaluate the effectiveness of open versus endovascular repair for INAAs.

Main Methods:

  • Retrospective cohort study of 70 patients with INAAs (2018-2023).
  • Analysis of demographics, microbiology, operative data, and follow-up outcomes.
  • Kaplan-Meier and Cox regression for survival and mortality predictors.

Main Results:

  • Common pathogens included Salmonella spp. and Burkholderia pseudomallei.
  • Open repair had higher reintervention rates; endovascular repair had more endoleaks and aortoenteric fistulas.
  • Early mortality was 2.8%, with 2-year survival at 89%. Age and ischemic heart disease predicted mortality.

Conclusions:

  • Both open and endovascular repairs are effective for INAAs, depending on patient factors.
  • Consider endemic pathogens like B. pseudomallei in tropical regions.
  • Long-term antibiotics, surveillance, and multidisciplinary care are key for optimal outcomes.

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