Ken Nakajima1, Noriyuki Kato2, Takashi Hashimoto2, Shuji Chino2, Takatoshi Higashigawa2, Takafumi Ouchi2, Toshiya Tokui3, Yoichiro Miyake4, Hajime Sakuma2. 1. Department of Radiology, Mie University Hospital, 2-174 Edobashi, Tsu, Mie 514-8507, Japan. Electronic address: k-nakajima@clin.medic.mie-u.ac.jp. 2. Department of Radiology, Mie University Hospital, 2-174 Edobashi, Tsu, Mie 514-8507, Japan. 3. Department of Cardiovascular Surgery, Ise Red Cross Hospital, Ise, Japan. 4. Department of Cardiovascular Surgery, Kochi Health Sciences Center, Kochi, Japan.
Abstract
PURPOSE: To evaluate the clinical utility of combination therapy with endovascular aneurysm repair (EVAR) and abscess drainage for the treatment of infected aneurysms. MATERIALS AND METHODS: Between July 2009 and May 2015, 8 patients underwent combination therapy with EVAR and abscess drainage. There were 5 men and 3 women, with a mean age of 75 years ± 7. Aneurysms were of the thoracic aorta in 5 patients, the abdominal aorta in 2, and the internal iliac artery in 1. Four patients had concurrent infection, including pyelonephritis in 2, pelvic abscess in 1, and suppurative knee arthritis in 1. Three patients had ruptured aneurysms. Abscess drainage was performed percutaneously under computed tomographic guidance in 5 patients, thoracoscopic guidance in 2, and both in 1. RESULTS: Six patients (75%) were discharged without additional intervention except for antibiotic therapy, and the other 2 patients (25%) underwent open repair to control infection and to repair endoleak, respectively. There were no in-hospital deaths. During the mean follow-up period of 48 months ± 22, all patients were alive except for 1 patient who died of recurrence of rectal cancer at 51 months. There were no aorta- or artery-related adverse events. Overall survival rates at 1 and 5 years were 100% and 80%, respectively. Aneurysm-related event-free rates at 1 and 5 years were 75%. CONCLUSIONS: Combination therapy with EVAR and abscess drainage for the treatment of infected aneurysms seems to be a promising strategy as an alternative or "bridge" to open surgery.
PURPOSE: To evaluate the clinical utility of combination therapy with endovascular aneurysm repair (EVAR) and abscess drainage for the treatment of infected aneurysms. MATERIALS AND METHODS: Between July 2009 and May 2015, 8 patients underwent combination therapy with EVAR and abscess drainage. There were 5 men and 3 women, with a mean age of 75 years ± 7. Aneurysms were of the thoracic aorta in 5 patients, the abdominal aorta in 2, and the internal iliac artery in 1. Four patients had concurrent infection, including pyelonephritis in 2, pelvic abscess in 1, and suppurative knee arthritis in 1. Three patients had ruptured aneurysms. Abscess drainage was performed percutaneously under computed tomographic guidance in 5 patients, thoracoscopic guidance in 2, and both in 1. RESULTS: Six patients (75%) were discharged without additional intervention except for antibiotic therapy, and the other 2 patients (25%) underwent open repair to control infection and to repair endoleak, respectively. There were no in-hospital deaths. During the mean follow-up period of 48 months ± 22, all patients were alive except for 1 patient who died of recurrence of rectal cancer at 51 months. There were no aorta- or artery-related adverse events. Overall survival rates at 1 and 5 years were 100% and 80%, respectively. Aneurysm-related event-free rates at 1 and 5 years were 75%. CONCLUSIONS: Combination therapy with EVAR and abscess drainage for the treatment of infected aneurysms seems to be a promising strategy as an alternative or "bridge" to open surgery.