Is endovascular repair of mycotic aortic aneurysms a durable treatment option?
OBJECTIVE
Endovascular repair for degenerative aortic aneurysms is well established, but its role in those with infective pathology remains controversial. This study aims to assess the durability of endovascular repair with a review of our midterm results.


METHODS
A retrospective analysis of a prospectively maintained endovascular database (1998-2008) was conducted, which identified 673 consecutive patients with aortic aneurysms.


RESULTS
Nineteen patients (2.8%) were identified with infected aortic aneurysms, in which there were a total of 23 separate aneurysms (16 thoracic and seven abdominal). Six patients (32%) presented with rupture. Eleven patients (58%) had received antibiotics preoperatively for a median duration of 11 days (1-54 days). Fifteen of the 19 (79%) had positive blood cultures, with Staphylococcus aureus being the most common organism. All 19 patients underwent endovascular repair. There were three Type I endoleaks (one requiring conversion to open repair) and two Type II endoleaks. One patient developed transient paraplegia, resolved by cerebrovascular fluid (CSF) drainage, and one patient had a stroke. The 30-day mortality was 11%, and survival at median follow-up of 20 months (0-83 months) was 73%. All eight deaths in the series were related to aneurysm.


CONCLUSIONS
Endovascular treatment of infective aortic pathology provides an early survival benefit; however, concerns over on-going graft infection remain.
Clough
R E
RE
Department of Vascular Surgery, Guy's and St Thomas' NHS Foundation Trust, London, UK.
Black
S A
SA
Lyons
O T
OT
Zayed
H A
HA
Bell
R E
RE
Carrell
T
T
Waltham
M
M
Sabharwal
T
T
Taylor
P R
PR
D000328:Adult; D000368:Aged; D000785:Aneurysm, Infected / Q000000981:diagnostic imaging / Q000382:microbiology / Q000401:mortality / Q000601:surgery*; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D017544:Aortic Aneurysm, Abdominal / Q000000981:diagnostic imaging / Q000401:mortality / Q000601:surgery*; D017545:Aortic Aneurysm, Thoracic / Q000000981:diagnostic imaging / Q000401:mortality / Q000601:surgery*; D001019:Aortic Rupture / Q000000981:diagnostic imaging / Q000401:mortality / Q000601:surgery; D001807:Blood Vessel Prosthesis; D005260:Female; D005402:Fistula / Q000000981:diagnostic imaging / Q000601:surgery; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D011446:Prospective Studies; D011859:Radiography; D012189:Retrospective Studies; D013211:Staphylococcus aureus / Q000302:isolation & purification; D015607:Stents; D016896:Treatment Outcome
D000900:Anti-Bacterial Agents