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

Abstract

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.

Mycotic Aortic Aneurysms

“…In their series, 51 patients (27%) were treated with open prosthetic repair, 56 (30%) with a biological material, and 80 were treated with EVAR (43%). Overall, open repairs were performed in 107 patients (57%) in this group, making this the largest series up to date on open aortic repair of MAAs [32]. In their analysis, blood and/or tissue culture were positive in 43 (77%) cases, 33 (59%) were positive for non-Salmonella infection, and 10 (18%) were positive for Salmonella species.…”

“…It presented a thirty-day survival of 95% (n = 53) and 90-day survival of 91% (n = 51). The overall treatment-related mortality was 9% (n = 5) [32].…”

“…Open surgical options include the use of antibiotic-soaked Dacron grafts, cryopreserved aortic allografts, and biological bovine pericardial materials. The use of the superficial femoral vein (SFV)and femoral or popliteal vein segments have also been used as an alternative to in situ reconstructions in aortic infections [26,32]. Revascularizations using vein grafts have the advantage of a potential lower risk of infection/reinfection.…”

“…The largest series to date on endovascular treatment of MAAs was reported in 2018 by Heinola et al This multicenter-group reported 187 MAAs treated in 6 different European countries between 2006 and 2016 [32]. Another previous large series on endovascular treatment of MAAs was reported in 2012 by Sedivy et al This series included 32 patients, treated during a 15-year period.…”

“…When present, pain is most commonly localized in the abdomen, chest, or back. Some groups have reported pain as the most common initial clinical symptom of MAAs, in up to 88% of patients [28,32]. It has been previously reported that the classic triad of mycotic aortic aneurysms includes fever, pulsatile mass, and back pain.…”