Skip to Content
Merck
  • Endovascular treatment of mycotic aortic aneurysms: a European multicenter study.

Endovascular treatment of mycotic aortic aneurysms: a European multicenter study.

Circulation (2014-11-08)
Karl Sörelius, Kevin Mani, Martin Björck, Petr Sedivy, Carl-Magnus Wahlgren, Peter Taylor, Rachel E Clough, Oliver Lyons, Matt Thompson, Jack Brownrigg, Krassi Ivancev, Meryl Davis, Michael P Jenkins, Usman Jaffer, Matt Bown, Zoran Rancic, Dieter Mayer, Jan Brunkwall, Michael Gawenda, Tilo Kölbel, Elixène Jean-Baptiste, Frans Moll, Paul Berger, Christos D Liapis, Konstantinos G Moulakakis, Marcus Langenskiöld, Håkan Roos, Thomas Larzon, Artai Pirouzram, Anders Wanhainen
ABSTRACT

Mycotic aortic aneurysm (MAA) is a rare and life-threatening disease. The aim of this European multicenter collaboration was to study the durability of endovascular aortic repair (EVAR) of MAA, by assessing late infection-related complications and long-term survival. All EVAR treated MAAs, between 1999 and 2013 at 16 European centers, were retrospectively reviewed. One hundred twenty-three patients with 130 MAAs were identified. Mean age was 69 years (range 39-86), 87 (71%) were men, 58 (47%) had immunodeficiency, and 47 (38%) presented with rupture. Anatomic locations were ascending/arch (n=4), descending (n=34), paravisceral (n=15), infrarenal aorta (n=63), and multiple (n=7). Treatments were thoracic EVAR (n=43), fenestrated/branched EVAR (n=9), and infrarenal EVAR (n=71). Antibiotic was administered for mean 30 weeks. Mean follow-up was 35 months (range 1 week to 149 months). Six patients (5%) were converted to open repair during follow-up. Survival was 91% (95% confidence interval, 86% to 96%), 75% (67% to 83%), 55% (44% to 66%), and 41% (28% to 54%) after 1, 12, 60, and 120 months, respectively. Infection-related death occurred in 23 patients (19%), 9 after discontinuation of antibiotic treatment. A Cox regression analysis demonstrated non-Salmonella-positive culture as predictors for late infection-related death. Endovascular treatment of MAA is feasible and for most patients a durable treatment option. Late infections do occur, are often lethal, and warrant long-term antibiotic treatment and follow-up. Patients with non-Salmonella-positive blood cultures were more likely to die from late infection.

MATERIALS
Product Number
Brand
Product Description

Sigma-Aldrich
Methyl acetoacetate, ReagentPlus®, ≥98.5% (GC)
Sigma-Aldrich
Methyl acetoacetate, Arxada quality, ≥99% (GC)