Karl Sörelius1, Kevin Mani1, Martin Björck1, Petr Sedivy1, Carl-Magnus Wahlgren1, Peter Taylor1, Rachel E Clough1, Oliver Lyons1, Matt Thompson1, Jack Brownrigg1, Krassi Ivancev1, Meryl Davis1, Michael P Jenkins1, Usman Jaffer1, Matt Bown1, Zoran Rancic1, Dieter Mayer1, Jan Brunkwall1, Michael Gawenda1, Tilo Kölbel1, Elixène Jean-Baptiste1, Frans Moll1, Paul Berger1, Christos D Liapis1, Konstantinos G Moulakakis1, Marcus Langenskiöld1, Håkan Roos1, Thomas Larzon1, Artai Pirouzram1, Anders Wanhainen2. 1. From the Institution of Surgical Sciences, Department of Vascular Surgery, Uppsala University, Sweden (K.S., K.M., M.B., A.W.); Department of Vascular Surgery, Na Homolce Hospital, Prague, Czech Republic (P.S.); Department of Vascular Surgery, Karolinska Hospital, Stockholm, Sweden (C.-M.W.); Department of Vascular Surgery, Guy's & St. Thomas' Hospital, London, United Kingdom (R.E.C., P.T., O.L.); St. George's Vascular Institute, London, United Kingdom (M.T., J. Brownrigg); Department of Vascular Surgery, Royal Free London NHS Foundation Trust, London, United Kingdom (K.I., M.D.); Regional Vascular Unit, St Mary's Hospital, Imperial College Healthcare NHS Trust, London, United Kingdom (M.P.J., U.J.); Department of Cardiovascular Sciences and the NIHR Leicester Cardiovascular Biomedical Research Unit, University of Leicester, Leicester, United Kingdom (M.B.); Clinic for Cardiovascular Surgery, University Hospital Zürich, Zürich, Switzerland (Z.R., D.M.); Department of Vascular Surgery, University of Cologne, Cologne, Germany (J. Brunkwall, M.G.); Department for Vascular Medicine, University Heart Center, University Hospital Eppendorf Hamburg, Hamburg, Germany (T.K.); Division of Vascular Surgery, University of Nice-Sophia Antipolis, Nice, France (E.J.-B.); Department of Vascular Surgery, University Medical Center Utrecht, Utrecht, The Netherlands (F.M., P.B.); Department of Vascular Surgery, Attikon University Hospital, Athens, Greece (C.D.L., K.G.M.); Department of Vascular Surgery, Sahlgrenska University Hospital, Gothenburg, Sweden (M.L., K.R.); and Department of Cardiothoracic and Vascular Surgery, Örebro University Hospital, Örebro, Sweden (T.L., A.P.). 2. From the Institution of Surgical Sciences, Department of Vascular Surgery, Uppsala University, Sweden (K.S., K.M., M.B., A.W.); Department of Vascular Surgery, Na Homolce Hospital, Prague, Czech Republic (P.S.); Department of Vascular Surgery, Karolinska Hospital, Stockholm, Sweden (C.-M.W.); Department of Vascular Surgery, Guy's & St. Thomas' Hospital, London, United Kingdom (R.E.C., P.T., O.L.); St. George's Vascular Institute, London, United Kingdom (M.T., J. Brownrigg); Department of Vascular Surgery, Royal Free London NHS Foundation Trust, London, United Kingdom (K.I., M.D.); Regional Vascular Unit, St Mary's Hospital, Imperial College Healthcare NHS Trust, London, United Kingdom (M.P.J., U.J.); Department of Cardiovascular Sciences and the NIHR Leicester Cardiovascular Biomedical Research Unit, University of Leicester, Leicester, United Kingdom (M.B.); Clinic for Cardiovascular Surgery, University Hospital Zürich, Zürich, Switzerland (Z.R., D.M.); Department of Vascular Surgery, University of Cologne, Cologne, Germany (J. Brunkwall, M.G.); Department for Vascular Medicine, University Heart Center, University Hospital Eppendorf Hamburg, Hamburg, Germany (T.K.); Division of Vascular Surgery, University of Nice-Sophia Antipolis, Nice, France (E.J.-B.); Department of Vascular Surgery, University Medical Center Utrecht, Utrecht, The Netherlands (F.M., P.B.); Department of Vascular Surgery, Attikon University Hospital, Athens, Greece (C.D.L., K.G.M.); Department of Vascular Surgery, Sahlgrenska University Hospital, Gothenburg, Sweden (M.L., K.R.); and Department of Cardiothoracic and Vascular Surgery, Örebro University Hospital, Örebro, Sweden (T.L., A.P.). anders.wanhainen@surgsci.uu.se.
Abstract
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.
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.