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Infected native aortic aneurysms: epidemiology, management, and outcomes based on a nationwide population-based study
Chih-Chun Lee1, Feng-Cheng Chang2, Ming-Jer Hsieh3
1Department of Psychiatry, Taipei City Psychiatric Center, Taipei City Hospital, Taipei, Taiwan.
European Heart Journal
|July 11, 2025
Summary
Open surgical repair offers better long-term survival for infected native aortic aneurysms (INAAs) than endovascular aortic repair (EVAR). EVAR may be a temporary option for high-risk patients when open repair isn't feasible.
Area of Science:
- Cardiovascular Surgery
- Infectious Diseases
- Vascular Surgery
Background:
- Infected native aortic aneurysms (INAAs) are rare but life-threatening emergencies.
- Large-scale longitudinal data on INAAs are lacking.
- This study investigates INAA epidemiology, treatment, and outcomes.
Purpose of the Study:
- To analyze the epidemiology, treatment trends, and outcomes of INAAs.
- To compare the effectiveness of different treatment modalities for INAAs.
- To identify factors influencing mortality in INAA patients.
Main Methods:
- Retrospective analysis of 2387 hospitalizations for INAAs (2001-2021) from the Taiwanese National Health Insurance Research Database.
- Assessment of in-hospital and post-discharge adverse events, including long-term mortality (1-10 years).
- Comparison of outcomes between conservative treatment, open repair, and endovascular aortic repair (EVAR).
Main Results:
- The INAA cohort (mean age 73.8 years, 77.6% male) showed an increasing trend over time.
- Comorbid renal insufficiency was prevalent (53%); common treatments included third-generation cephalosporins and anti-MRSA agents.
- Conservative treatment had the highest mortality. EVAR had lower in-hospital mortality (OR 0.76) but higher long-term mortality (HR 1.13) compared to open repair.
Conclusions:
- Open surgical repair is associated with significantly better post-discharge survival for INAAs.
- EVAR may be a temporizing or palliative option for selected high-risk patients when open repair is not immediately feasible.
- Optimal management of INAAs emphasizes the importance of open repair for long-term survival.
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