title: Open and endovascular repair of primary mycotic aortic aneurysms: a 10-year single-center experience.
abstract: OBJECTIVE
  To report early and midterm outcomes after open or endovascular repair of primary mycotic aortic aneurysms treated over a 10-year period in a single center.
  
  
  METHODS
  The records of all 12 patients (10 men; 72.9 years, range 59-83) treated for primary mycotic aortic aneurysms from September 2001 to December 2010 were retrospectively reviewed. The aneurysms were located in the abdominal aorta in 10 cases and in the thoracic aorta in 2. Preoperative signs of infection, such as leukocytosis or elevated C-reactive protein, were found in all patients, and fever was apparent in 7. Three patients had primary open surgery with extensive debridement and extra-anatomical bypass, while 9 patients underwent endovascular aneurysm repair. At the time of operation, 10 mycotic aneurysms were already ruptured. All patients were prescribed lifelong antibiotics after discharge.
  
  
  RESULTS
  Positive microbial cultures were found in 8 patients, including Salmonella species in 2, S. aureus in 3, E. coli in 1, and Streptococcus in 1. Mean follow-up was 29.9 months (range 1-98). Five patients took lifelong oral antibiotics after discharge with a mean medication duration of 17 months (range 1-65). Two of the 3 open surgery patients died (1 early). In the 9 endovascular repair patients, there was no early mortality, but 1 patient died at 6 months of an unknown cause. Additionally, 6 patients had a late relapse and underwent either secondary open surgical debridement (n=2) or computed tomography-guided drainage and antibiotic flush; 3 of the 6 died.
  
  
  CONCLUSIONS
  Endovascular aneurysm repair is a reasonable short-term management for patients with hemodynamic instability or high surgical risk. However, the late relapse rate after endovascular repair was very high in this series, despite adjunctive drainage and aggressive antibiotic treatment.
authors.affiliation: Department of Vascular Surgery, Chinese PLA General Hospital, Beijing, China.
authors.forename: Xin
authors.initials: X
authors.lastname: Jia
authors.forename: Yan-fen
authors.initials: YF
authors.lastname: Dong
authors.forename: Xiao-ping
authors.initials: XP
authors.lastname: Liu
authors.forename: Jiang
authors.initials: J
authors.lastname: Xiong
authors.forename: Hong-peng
authors.initials: HP
authors.lastname: Zhang
authors.forename: Wei
authors.initials: W
authors.lastname: Guo
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000785:Aneurysm, Infected / Q000150:complications / Q000601:surgery*; D001014:Aortic Aneurysm / Q000150:complications / Q000601:surgery*; D003646:Debridement; D057510:Endovascular Procedures; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome; D014656:Vascular Surgical Procedures / Q000379:methods*