The changing management of primary mycotic aortic aneurysms

Objective The objective of this study is to examine contemporary management of primary mycotic aortic aneurysms in a single center. We have previously reported the management of mycotic aortic aneurysms in 15 patients between 1991 and 2001, and we hypothesized that management would change in the lig...

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Published in:Journal of vascular surgery 2011-08, Vol.54 (2), p.334-340
Main Authors: Vallejo, Nadia, MD, Picardo, Natasha Emma, MRCS, Bourke, Patricia, BSc, Bicknell, Colin, MD, FRCS, Cheshire, Nicholas J.W., MD, FRCS, Jenkins, Michael P., MS, FRCS, Wolfe, John, MS, FRCS, Gibbs, Richard G.J., MD, FRCS
Format: Article
Language:English
Subjects:
Aged
Aged, 80 and over
Aneurysm, Infected - diagnostic imaging
Aneurysm, Infected - microbiology
Aneurysm, Infected - mortality
Aneurysm, Infected - surgery
Aortic Aneurysm - diagnostic imaging
Aortic Aneurysm - microbiology
Aortic Aneurysm - mortality
Aortic Aneurysm - surgery
Aortic Rupture - diagnostic imaging
Aortic Rupture - microbiology
Aortic Rupture - mortality
Aortic Rupture - surgery
Aortography - methods
Biological and medical sciences
Blood and lymphatic vessels
Blood Vessel Prosthesis Implantation - adverse effects
Blood Vessel Prosthesis Implantation - mortality
Cardiology. Vascular system
Databases as Topic
Diseases of the aorta
Endovascular Procedures - adverse effects
Endovascular Procedures - mortality
Female
Humans
London
Male
Medical sciences
Middle Aged
Surgery
Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases
Time Factors
Tomography, X-Ray Computed
Treatment Outcome
Vascular surgery: aorta, extremities, vena cava. Surgery of the lymphatic vessels
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Summary:Objective The objective of this study is to examine contemporary management of primary mycotic aortic aneurysms in a single center. We have previously reported the management of mycotic aortic aneurysms in 15 patients between 1991 and 2001, and we hypothesized that management would change in the light of the evolution of endovascular aortic repair. Methods A review of a prospectively collected database (2002-2009) of all patients presenting with mycotic aneurysms. Results A total of 19 aneurysms were identified in 17 patients (12 men, 5 women) with a median age of 66.2 years (range, 49-82 years). All were symptomatic, and nine had contained rupture. There were five infrarenal, two juxtarenal, three Crawford type III, four type IV thoracoabdominal aortic aneurysms, and five descending thoracic aneurysms in the series. All thoracic aneurysms were excluded by thoracic endovascular aneurysm repair. Two patients underwent visceral hybrid endografting for type III thoracic aortic aneurysm; the third was treated with open repair. Four patients underwent open type IV repair. Two of the infrarenal aneurysms were treated with bifurcated endovascular aneurysm repair, and the other three and both juxtarenals with open repair with in situ reconstruction. There were three early (17.6%) and three late deaths (17.6%). The median follow-up was 30.5 months (range, 1-102 months). Conclusions The results of the latest series show that open surgery is still required in many cases. The introduction of endovascular techniques in the exclusion of mycotic aneurysms can be accomplished with acceptable results, and endovascular treatment has increased the therapeutic options for a difficult condition.
ISSN:0741-5214
1097-6809
DOI:10.1016/j.jvs.2010.12.066