Long‐term outcome of endovascular aortic repair for mycotic abdominal aortic aneurysm

Abstract

BackgroundThis study aimed to evaluate the feasibility and efficacy of endovascular treatment for mycotic abdominal aortic aneurysm (AAA) with long‐term follow‐up time period.MethodsPatients with mycotic AAA treated with endovascular aortic repair between January 2009 and December 2017 were included in this study. The preoperative and long‐term outcomes during follow‐up were reviewed and analysed.ResultsSixteen patients (12 males and four females with a mean age of 57.6 ± 14.1 years) were included in this study. The technical success rate was 100%. There were no preoperative mortalities, and one instance of deep venous thrombosis during hospitalization was recorded. The median follow‐up time period was 41.2 (interquartile range 24.8–69.7) months, and the late mortality rate was 12.5%. Three (18.8%) patients presented with reinfection during follow‐up. One patient presented with abdominal abscess and recurrent juxtarenal aortic aneurysm at 40 months post‐operatively, and he received hybrid surgery and abdominal debridement and drainage. One patient developed staphylococcal bloodstream sepsis at 3 months post‐operatively and the other patient developed Salmonella bloodstream sepsis at 9 months post‐operatively. Pathogenic bacteria were consistent with the previous results. They both recovered after 2 months of intravenous antibiotic treatment. At present, all three patients are still alive without endograft infection and receiving outpatient follow‐up. The aneurysm diameter decreased by more than 5 mm among five patients and remained stable in 10 patients at 1 year post‐operatively.ConclusionEndovascular aortic repair is a feasible and effective method of treating mycotic AAA with an acceptable reinfection rate from our single‐centre experience.

Aneurisma infeccioso primário da aorta: série de casos e revisão da literatura

“… 5 , 11 The name infectious aortitis could denote several different conditions, such as aortoenteric fistulas and infections after surgical manipulation, including infections of aortic grafts. 5 , 8 , 12 - 14 The best term is primary infectious aneurysm, which denotes a dilation secondary to infection of the aorta wall. 2 , 5 , 11 , 14 , 15 The condition is rare, 1 , 5 - 7 , 9 , 16 but highly lethal.…”

“…In the West, infectious aneurysms account for no more than 3% of all aneurysms 1 , 2 , 5 , 6 , 8 , 9 , 11 , 14 , 16 - 18 and tend to occur in men 8 , 14 who are younger than those who develop degenerative aneurysms. 4 , 7 , 11 These aneurysms can grow rapidly and there is a high risk of rupture, 2 , 4 , 8 , 9 , 12 , 16 , 17 with mortality rates as high as 60%. 2 The following etiologic agents have been reported: gram-positive bacteria such as Staphylococcus sp.…”

“… 5 , 11 , 18 The most frequently identified agents are members of the Staphylococcus and Salmonella genera. 6 , 12 , 18 The source of infection is not identified in 1/3 of cases and the etiologic agent is not established in 20-40% of cases. 11 , 14 , 15 Infectious aneurysms can be caused by contiguity 21 or, frequently, by bacteremia.…”

“…Early diagnosis is key to therapeutic success. 6 , 8 , 9 , 12 , 16 Classically, there is fever, 1 , 3 , 4 , 6 - 8 , 14 , 18 abdominal/lumbar pains, and a pulsating mass 1 , 4 , 6 - 8 , 14 , 18 in the presence of an infectious condition (osteomyelitis, urinary infections, tuberculosis, gastroenteritis, and soft tissue infections) 1 , 4 , 6 , 11 , 14 and/or immunosuppression caused by diseases or medications (cancer, renal failure requiring dialysis, HIV, diabetes, corticosteroids). However, asymptomatic cases can also occur.…”

“… 4 , 14 All three of the cases reported above had abdominal pains; cases 1 and 2 had a history of an infectious condition, and there was also use of immunosuppressant medication in case 1. Laboratory tests generally show Leukocytosis 1 , 6 , 8 , 11 , 12 , 14 and inflammatory markers such as elevated ESR and CRP, 6 , 12 in addition to positive blood cultures. 1 , 3 , 4 , 6 , 7 , 16 However, blood cultures can be negative even during the acute phase in up to 50% of cases, 14 , 23 particularly in patients who are being given antibiotics, which is common.…”