Endovascular Treatment of Mycotic Aortic Aneurysms: A European Multicenter Study
Background—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 repair (EVAR) of MAA, by assessing late infection-related complications and long-term survival.
Methods and Results—All EVAR treated MAAs, between 1999 and 2013 at 16 European centers, were retrospectively reviewed. 123 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. Anatomical 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-149 months). Six patients (5%) were converted to open repair during follow-up. Survival was 91% (95% CI 86-96%), 75% (67-83%), 55% (44-66%), and 41% (28-54%) after 1-, 12-, 60-, and 120-months, respectively. Infection-related death occurred in 23 patients (19%) in whom 9 after discontinuation of ABx-treatment. A Cox regression analysis demonstrated non-Salmonella positive culture as predictors for late infection-related death.
Conclusions—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.
- Received February 14, 2014.
- Revision received September 14, 2014.
- Accepted September 18, 2014.