Endovascular treatment of primary mycotic aortic aneurysms: a 7-year single-center experience

Abstract

ObjectiveThis study was performed to assess the efficacy and outcome of endovascular aneurysm repair (EVAR) for treatment of primary mycotic aortic aneurysms (PMAAs).MethodsFourteen consecutive patients who presented with PMAA from April 2010 to July 2017 were retrospectively reviewed. Preoperative, intraoperative, and postoperative clinical data were recorded, and late infection-related complications and long-term survival were assessed.ResultsThe aneurysms were located in the abdominal aorta in 10 patients and in the left common iliac artery in 4 patients. Positive microbial cultures were found in 12 patients, including Salmonella species in 11 and Streptococcus in 1. The remaining two patients had negative culture results. Ten patients received preoperative antibiotics before elective EVAR for 7 ± 9 days after admission. Four patients who underwent emergent EVAR due to ruptured aneurysms were given their first dose of antibiotics before EVAR. Three patients underwent surgical drainage, and six underwent percutaneous drainage within 30 days after EVAR. No death occurred within 30 days of the initial procedure. The mean follow-up was 34.8 (range, 3–84 months). One patient underwent re-intervention to resolve obstruction of the iliac/femoral artery 5 months postoperatively. Relapse of infection occurred in six patients (42.8%) during follow-up; infection-related death occurred in three of these patients. The other patients recovered with either conversion to open radical surgery or medical therapy. The actuarial 7-year survival after EVAR was 75.7%.ConclusionsEVAR and aggressive antibiotic therapy might be suitable for PMAAs. Favorable results may be typical for infection caused by Salmonella.

A strobe multicenter descriptive study of 55 infectious aortitis

“… [38] Open surgery with replacement of the aorta – be it with prosthesis or allograft – has long been considered the gold-standard treatment of infectious AA but numerous case-reports show that there is a growing resort to endovascular aneurysm repair (EVAR) techniques. [ 19 39 ]…”

Surgical management of ruptured mycotic aortic aneurysm induced by Klebsiella pneumoniae

“…Mycotic aortic aneurysm (MAA) is a rare but severe disease representing less than 1% of all aortic aneurysms. [1,2] Although MAAs have decreased gradually owing to the development and popularization of antibiotics, its rapid development and high rupture rate have resulted in a very poor prognosis. [1,2] Recently, the most common cause of MAAs reported worldwide has been Staphylococcus aureus , followed by Salmonella which is more common in East Asia.…”

“…[1,2] Although MAAs have decreased gradually owing to the development and popularization of antibiotics, its rapid development and high rupture rate have resulted in a very poor prognosis. [1,2] Recently, the most common cause of MAAs reported worldwide has been Staphylococcus aureus , followed by Salmonella which is more common in East Asia. [1,2] Klebsiella and Mycobacterium have also been reported as rarer causes of MAAs.…”

“…[1,2] Recently, the most common cause of MAAs reported worldwide has been Staphylococcus aureus , followed by Salmonella which is more common in East Asia. [1,2] Klebsiella and Mycobacterium have also been reported as rarer causes of MAAs. [2–4] Our authors have already reported a rare case of MAA induced by Mycobacterium .…”

“…Both embolization of microorganisms and iatrogenic factors might cause vascular endothelial damage, providing an opportunity to microorganisms to invade the arterial wall. [1,2] Once the arterial wall has been damaged by an infection, it becomes fragile. [1] The damaged wall cannot sustain systemic arterial pressure, which might lead to a pseudoaneurysm and rupture.…”