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Conclusions: This study demonstrates a paradigm shift in the treatment of primary mycotic abdominal aortic aneurysms (MAAAs) in Sweden to the use of endovascular aneurysm repair (EVAR) as the preferred modality. EVAR was associated with improved short-term survival in comparison to open repair and without a higher incidence of serious infectious complications or reoperations.Summary: This retrospective study of a prospectively collected nationwide database spanned 10 years . All patients treated for a primary MAAAs were identified in the Swedish vascular registry (Swedvasc). The primary aim was assessment of survival after open repair (OR) or EVAR of a MAAA. Secondary end points were analysis of the rate of recurrent infections and reoperations as well as the time trends in surgical treatment. Propensity score-weighted correction for risk factors in the 2 groups was performed including the operative year to account for differences in treatment and outcome over time. One hundred and thirty-two patients were identified (0.6% of all AAA repairs) with mean age of 70. Rupture was the presenting symptom in 50 patients. Overall survival was 86% at 3 months, 79% at 1 year, and 59% at 5 years. The treatment modality shifted over this study, EVAR was not used prior to 2001 (n ¼ 14 repairs), jumped to 58% during 2001-2007 (n ¼ 43 repairs), and was used 60% of the time during 2008-2014 (n ¼ 75 repairs). Eight patients had multiple aortic aneurysms defined as a combination of infrarenal, paravisceral, and/or thoracic. The most common infectious agents were Streptococcus (22%), Staphlococcus (16%), and Salmonella (9%). Of the 62 patients treated with open repair, 50 were in situ reconstructions, 7 aortic resections and extra-anatomic bypasses, and 3 patch angioplasties. Two patients died

Background-Mycotic aortic aneurysm (MAA) is a rare and life-threatening disease. The aim of this European multicenter collaboration was to study the durability of endovascular aortic repair (EVAR) of MAA, by assessing late infectionrelated complications and long-term survival. Methods and Results-All EVAR treated MAAs, between 1999 and 2013 at 16 European centers, were retrospectively reviewed. One hundred twenty-three patients with 130 MAAs were identified. Mean age was 69 years (range 39-86), 87 (71%) were men, 58 (47%) had immunodeficiency, and 47 (38%) presented with rupture. Anatomic locations were ascending/arch (n=4), descending (n=34), paravisceral (n=15), infrarenal aorta (n=63), and multiple (n=7). Treatments were thoracic EVAR (n=43), fenestrated/branched EVAR (n=9), and infrarenal EVAR (n=71). Antibiotic was administered for mean 30 weeks. Mean follow-up was 35 months (range 1 week to 149 months). Six patients (5%) were converted to open repair during follow-up. Survival was 91% (95% confidence interval, 86% to 96%), 75% (67% to 83%), 55% (44% to 66%), and 41% (28% to 54%) after 1, 12, 60, and 120 months, respectively. Infection-related death occurred in 23 patients (19%), 9 after discontinuation of antibiotic treatment. A Cox regression analysis demonstrated non-Salmonellapositive culture as predictors for late infection-related death. Conclusions-Endovascular

This study demonstrates a paradigm shift in treatment of MAAA in Sweden, with EVAR being the preferred treatment modality. EVAR was associated with improved short-term survival in comparison with OR, without higher associated incidence of serious infection-related complications or reoperations.