Endovascular Treatment of Infected Aortic Aneurysms

Šedivý, Petr; Špaček, Miroslav; Samman, Khaled El; Bělohlávek, Otakar; Mach, T; Jindrák, Vlastimil; Rohn, Vilém; Štádler, P

doi:10.1016/j.ejvs.2012.07.011

Cited by 80 publications

(62 citation statements)

References 33 publications

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“…Yet non‐ Salmonella infections are known to be associated with higher aneurysm‐related complications and death after treatment 2, 3, 10, 36. In the current study, none of them was significantly associated with death or reinfections.…”

Section: Discussioncontrasting

confidence: 47%

“…Articles published on prosthetic reconstructions emphasize preoperative antimicrobial therapy at least 1 week for stable patients to eliminate bacteremia and impregnate surrounding tissue with antibiotics, yet the evidence for less postoperative infectious complications is lacking 7, 12, 35. The duration of antimicrobial therapy remains unclear, depending on the surgical method and postoperative course, varying from 6 weeks to lifelong 10, 11, 12, 35, 36. With close surveillance, antibiotics may be discontinued in selected cases, provided there is no clinical, hematological, or radiological prove of ongoing infection.…”

Section: Discussionmentioning

confidence: 99%

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Open Repair of Mycotic Abdominal Aortic Aneurysms With Biological Grafts: An International Multicenter Study

Heinola

Sörelius

Wyss

et al. 2018

JAHA

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BackgroundThe treatment of mycotic abdominal aortic aneurysm requires surgery and antimicrobial therapy. Since prosthetic reconstructions carry a considerable risk of reinfection, biological grafts are noteworthy alternatives. The current study evaluated the durability, infection resistance, and midterm outcome of biological grafts in treatment of mycotic abdominal aortic aneurysm.Methods and ResultsAll patients treated with biological graft in 6 countries between 2006 and 2016 were included. Primary outcome measures were 30‐ and 90‐day survival, treatment‐related mortality, and reinfection rate. Secondary outcome measures were overall mortality and graft patency. Fifty‐six patients (46 males) with median age of 69 years (range 35–85) were included. Sixteen patients were immunocompromised (29%), 24 (43%) had concomitant infection, and 12 (21%) presented with rupture. Bacterial culture was isolated from 43 (77%). In‐situ aortic reconstruction was performed using autologous femoral veins in 30 patients (54%), xenopericardial tube‐grafts in 12 (21%), cryopreserved arterial/venous allografts in 9 (16%), and fresh arterial allografts in 5 (9%) patients. During a median follow‐up of 26 months (range 3 weeks–172 months) there were no reinfections and only 3 patients (5%) required assistance with graft patency. Thirty‐day survival was 95% (n=53) and 90‐day survival was 91% (n=51). Treatment‐related mortality was 9% (n=5). Kaplan–Meier estimation of survival at 1 year was 83% (95% confidence interval, 73%–94%) and at 5 years was 71% (52%–89%).ConclusionsMycotic abdominal aortic aneurysm repair with biological grafts is a durable option for patients fit for surgery presenting an excellent infection resistance and good overall survival.

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Section: Discussioncontrasting

confidence: 47%

Section: Discussionmentioning

confidence: 99%

Open Repair of Mycotic Abdominal Aortic Aneurysms With Biological Grafts: An International Multicenter Study

Heinola

Sörelius

Wyss

et al. 2018

JAHA

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“…The largest study of open surgical treatment of MAA was published in 2011 by Yu et al 15 from Taiwan and consisted of 54 patients, and the largest study on endovascular treatment, published in 2012 by Sedivy et al 13 from The Czech Republic, included 32 patients. The disease is difficult to study because of its rarity, therefore large-scale multicenter collaborations are necessary.…”

Section: Discussionmentioning

confidence: 99%

“…[10][11][12][13] The crucial question of durability therefore remains unanswered. The aim of this European multicenter collaboration was to study the durability of endovascular treatment of MAA, by assessing the late infectionrelated complications and long-term survival.…”

Section: Editorial See P 2129 Clinical Perspective On P 2142mentioning

confidence: 99%

Endovascular Treatment of Mycotic Aortic Aneurysms

et al. 2014

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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

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“…Furthermore, for infected aneurysms affecting the thoracic aorta and aortic arch, the surgical procedure typically employs extracorporeal circulation, cardiopulmonary bypass, and even a period of deep hypothermic circulatory arrest (DHCA), further increasing the operative risks. The feasibility of endovascular aortic repair (EVAR) for infected aortic aneurysms has been investigated in numerous studies, which in turn provided encouraging short-term results [18,42,[70][71][72][73][74]. However, the long-term survival and late-onset complications, especially recurrent or persistent infections, are of greater concerns [74].…”

Section: Managementmentioning

confidence: 99%

Infected Aortic Aneurysms

Lin¹,

Kan²

2017

Aortic Aneurysm

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Infected aortic aneurysms are surgical urgencies, requiring prompt management to avoid the development of catastrophic complications. Although traditional open surgery composed of radical debridement and aortic reconstruction remains the gold-standard, many favorable results of the endovascular repair strategy have been reported. In this chapter, the etiology, bacteriology, clinical manifestation, and diagnostic criteria of infected aortic aneurysms will be discussed in detail at first, followed by a comprehensive review of both traditional open surgery and endovascular repair, based on current evidences and the authors' institutional experience. Along with long-term oral antibiotic suppression and aggressive adjunctive procedures, endovascular repair for uncomplicated infected aortic aneurysms could be a definite treatment alternative to traditional open surgery in the endovascular era.

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Endovascular Treatment of Infected Aortic Aneurysms

Abstract: The implantation of a SG may be an alternative to open surgery in selected groups of patients with primary IAA. Aneurysms of the central part of the thoracic or abdominal aorta have a more favorable prognosis with endovascular treatment.

Cited by 80 publications

References 33 publications

Open Repair of Mycotic Abdominal Aortic Aneurysms With Biological Grafts: An International Multicenter Study

Open Repair of Mycotic Abdominal Aortic Aneurysms With Biological Grafts: An International Multicenter Study

Endovascular Treatment of Mycotic Aortic Aneurysms

Infected Aortic Aneurysms

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