Nationwide Study on Treatment of Mycotic Thoracic Aortic Aneurysms

Research output: Contribution to journalArticle

Abstract

Objective/background: Mycotic aortic aneurysms are rare, life threatening, and complex. This nationwide study aimed to assess outcome after repair of mycotic thoracic aortic aneurysms (MTAAs). Methods: Patients treated in Sweden for MTAAs between 2000 and 2016 were identified in the Swedish vascular registry (2010–16) and local patient registries (2000–09). Primary outcome was survival, and secondary outcomes included surgical strategy, rate of infection related complications (IRC), and re-operations. Results: Fifty-two patients (median age 71 ± 8.1 years; 28 [54%] men, 13 [25%] ruptured) were identified (3.6% of all thoracic aortic aneurysm repairs in Sweden). Aneurysm location was aortic arch (n = 6; 11%), descending aorta (n = 42; 81%), and multiple locations (n = 4; 8%). Twenty-nine (56%) patients had positive cultures; the most prevalent agent was Staphylococcus aureus (n = 16; 31%). Operative techniques included thoracic endovascular aortic repair (TEVAR; n = 35 [67%]), fenestrated/branched TEVAR (n = 8; 15%), hybrid repair (n = 7; 14%), and open patch repair (n = 2; 4%). Survival was 92% (95% confidence interval [CI] 88–96) at 30 days, 88% (95% CI 84–93) at three months, 78% (73–84) at one year, and 71% (64–77) at five years. The mean follow up among survivors (> 90 days) was 45 months (range 4–216 months). Antibiotics were administered for a median of 15 weeks (range 0–220 weeks). IRCs occurred in nine patients (17%): sepsis (n = 3), graft infection (n = 3), recurrent mycotic aneurysm (n = 1), aorto-oesophageal/bronchial fistula (n = 2). Six (67%) IRCs were fatal; 80% occurred within the first year. Re-operations were performed in nine patients (17%). Conclusions: TEVAR was often used as treatment for MTAAs, with acceptable short- and long-term survival when compared with open cohorts in the literature. IRCs are of concern and warrant follow up and long-term antibiotic treatment.

Details

Authors
  • K. Sörelius
  • A. Wanhainen
  • C. M. Wahlgren
  • M. Langenskiöld
  • H. Roos
  • T. Resch
  • R. Vaccarino
  • B. Arvidsson
  • P. Gillgren
  • L. Bilos
  • A. Pirouzram
  • M. Holsti
  • K. Mani
Organisations
External organisations
  • Uppsala University
  • Karolinska University Hospital
  • Sahlgrenska University Hospital
  • Linköping University
  • Karolinska Institutet
  • Södersjukhuset
  • Örebro University Hospital
  • Norrland University Hospital
Research areas and keywords

Subject classification (UKÄ) – MANDATORY

  • Cardiac and Cardiovascular Systems
  • Surgery

Keywords

  • Aneurysm, Aorta, Infected, Mycotic, Thoracic, Treatment
Original languageEnglish
Pages (from-to)239-246
JournalEuropean Journal of Vascular and Endovascular Surgery
Volume57
Issue number2
Publication statusPublished - 2019
Publication categoryResearch
Peer-reviewedYes