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Is Endovascular Repair of Mycotic Aortic Aneurysms a Durable Treatment Option?

Abstract Objective Endovascular repair for degenerative aortic aneurysms is well established, but its role in those with infective pathology remains controversial. This study aims to assess the durability of endovascular repair with a review of our midterm results. Method A retrospective analysis of...

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Bibliographic Details
Published in:European journal of vascular and endovascular surgery 2009-04, Vol.37 (4), p.407-412
Main Authors: Clough, R.E, Black, S.A, Lyons, O.T, Zayed, H.A, Bell, R.E, Carrell, T, Waltham, M, Sabharwal, T, Taylor, P.R
Format: Article
Language:English
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Summary:Abstract Objective Endovascular repair for degenerative aortic aneurysms is well established, but its role in those with infective pathology remains controversial. This study aims to assess the durability of endovascular repair with a review of our midterm results. Method A retrospective analysis of a prospectively maintained endovascular database (1998–2008) was conducted, which identified 673 consecutive patients with aortic aneurysms. Results Nineteen patients (2.8%) were identified with infected aortic aneurysms, in which there were a total of 23 separate aneurysms (16 thoracic and seven abdominal). Six patients (32%) presented with rupture. Eleven patients (58%) had received antibiotics preoperatively for a median duration of 11 days (1–54 days). Fifteen of the 19 (79%) had positive blood cultures, with Staphylococcus aureus being the most common organism. All 19 patients underwent endovascular repair. There were three Type I endoleaks (one requiring conversion to open repair) and two Type II endoleaks. One patient developed transient paraplegia, resolved by cerebrovascular fluid (CSF) drainage, and one patient had a stroke. The 30-day mortality was 11%, and survival at median follow-up of 20 months (0–83 months) was 73%. All eight deaths in the series were related to aneurysm. Conclusion Endovascular treatment of infective aortic pathology provides an early survival benefit; however, concerns over on-going graft infection remain.
ISSN:1078-5884
1532-2165
DOI:10.1016/j.ejvs.2008.11.025