TY - JOUR
T1 - Endovascular treatment of mycotic aortic aneurysms
T2 - a European multicenter study
AU - Srelius, Karl
AU - Mani, Kevin
AU - Bjrck, Martin
AU - Sedivy, Petr
AU - Wahlgren, Carl Magnus
AU - Taylor, Peter
AU - Clough, Rachel
AU - Lyons, Oliver
AU - Thompson, Matt
AU - Brownrigg, Jack
AU - Ivancev, Krassi
AU - Davis, Meryl
AU - Jenkins, Michael P.
AU - Jaffer, Usman
AU - Bown, Matt
AU - Rancic, Zoran
AU - Mayer, Dieter
AU - Brunkwall, Jan
AU - Gawenda, Michael
AU - Kölbel, Tilo
AU - Jean-Baptiste, Elixène
AU - Moll, Frans
AU - Berger, Paul
AU - Liapis, Christos D.
AU - Moulakakis, Konstantinos G.
AU - Langenskiöld, Marcus
AU - Roos, Håkan
AU - Larzon, Thomas
AU - Pirouzram, Artai
AU - Wanhainen, Anders
PY - 2014/12/9
Y1 - 2014/12/9
N2 - 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 aortic 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. 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.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.
AB - 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 aortic 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. 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.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.
KW - aneurysm
KW - aorta
KW - infection
KW - surgery
UR - http://www.scopus.com/inward/record.url?scp=84918510456&partnerID=8YFLogxK
U2 - 10.1161/CIRCULATIONAHA.114.009481
DO - 10.1161/CIRCULATIONAHA.114.009481
M3 - Article
AN - SCOPUS:84918510456
SN - 0009-7322
VL - 130
SP - 2136
EP - 2142
JO - Circulation (Baltimore)
JF - Circulation (Baltimore)
IS - 24
ER -