title: Clinical, microbiologic, and outcome analysis of mycotic aortic aneurysm: the role of endovascular repair.
abstract: BACKGROUND
  Mycotic aortic aneurysm (MAA) is an infrequent but devastating form of vascular disease.
  
  
  METHODS
  We conducted a retrospective cohort study at a major medical center to identify independent risk factors for MAA and to provide opinions about treating it. The study population consisted of 43 patients who had had 44 MAAs over a period of 15 y.
  
  
  RESULTS
  All of the patients had positive blood cultures, radiologic findings typical of MAA, and clinical signs of infection (leukocytosis, fever, and elevated C-reactive protein). The mean age of the patients was 63.8±10.6 y and the mean period of their follow up was 35.7±39.3 mo. Twenty-nine patients with MAAs underwent traditional open surgery, 11 others received endovascular stent grafts, and four MAAs were managed conservatively. The most frequent causative pathogens were Salmonella (36/44 patients [81.8%]), in whom organisms of Salmonella serogroup C (consisting mainly of S. choleraesuis) were identified in 14 patients, organisms of Salmonella serogroup D were identified in 13 patients, and species without serogroup information were identified in nine patients. The overall mortality in the study population was 43.2% (with an aneurysm-related mortality of 18.2%, surgically related mortality of 13.6%, and in-hospital mortality of 22.7%).
  
  
  CONCLUSIONS
  Shock is a risk factor for operative mortality. Misdiagnosis and treatment of MAA as low back pain, co-existing connective-tissue disease such as systemic lupus erythematosus and rheumatoid arthritis, and Salmonella serogroup C-associated bacteremia are risk factors for aneurysm-related death. Endovascular repair should be considered as an alternative option to the open repair of MAA.
authors.affiliation: 1 Graduate Institute of Clinical Medicine, College of Medicine, Taipei Medical University , Taipei, Taiwan .
authors.forename: Yao-Kuang
authors.initials: YK
authors.lastname: Huang
authors.forename: Chyi-Liang
authors.initials: CL
authors.lastname: Chen
authors.forename: Ming-Shian
authors.initials: MS
authors.lastname: Lu
authors.forename: Feng-Chun
authors.initials: FC
authors.lastname: Tsai
authors.forename: Pyng-Ling
authors.initials: PL
authors.lastname: Lin
authors.forename: Chih-Hsiung
authors.initials: CH
authors.lastname: Wu
authors.forename: Cheng-Hsun
authors.initials: CH
authors.lastname: Chiu
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000785:Aneurysm, Infected / Q000453:epidemiology / Q000382:microbiology* / Q000473:pathology* / Q000601:surgery; D001014:Aortic Aneurysm / Q000453:epidemiology / Q000382:microbiology* / Q000473:pathology* / Q000601:surgery; D015331:Cohort Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors; D012475:Salmonella / Q000145:classification / Q000302:isolation & purification; D012480:Salmonella Infections / Q000150:complications*; D016896:Treatment Outcome