Management of Infectious Aortic Aneurysms: Short- and Mid-TermOutcomes

Abstract

Background: Infectious aortic aneurysms are a rare but life-threatening condition due to their rapid development. Their management is multidisciplinary. The main purpose of this study was to evaluate the mortality of patients treated for infectious aortic aneurysm (IAA) by different types of treatments. Secondary objectives were to evaluate infectious recurrences and the factors influencing mortality with this management.

Methods: Between September 2009 and October 2023, all the patients with an IAA confirmed by the clinical, biological, microbiological, radiological, and nuclear medicine data were included. Standard treatment included preoperative and postoperative antibiotics and open radical surgery with reconstruction using biological material. Endovascular treatment was used in patients with contraindication to open surgery. An alternative "bridge" technique was proposed in emergencies and consisted of the placement of a covered stent graft followed by secondary open surgical reconstruction. The clinical, biological, bacteriological, and imaging data were collected in the Retrospective and Prognostic Registry of Aortic Infections registry, with a 30-day, 1-year, and 3-year evaluation. Infectious recurrences were studied.

Results: The IAA diagnosis was confirmed in 47 patients with a mean age of 67 ± 10.8 years. Aneurysms were located in the arch (4%), the descending thoracic aorta (21%), the thoracoabdominal aorta (30%), the juxta-renal (4%), and the infrarenal abdominal (41%) aorta. The involved microorganisms were methicillin-sensitive S. aureus (43%), Salmonella (13%), E. coli (9%), and other species (35%). Radical surgery was performed in 27 patients (57.4%): bovine pericardial tubular xenografts and cryopreserved allografts were used in 22 and 3 cases, respectively. Endovascular treatment was performed in 12 patients (25.5%) Medical treatment only was used in 8 cases (17%). The overall 30-day, 1-year, and 3-years survival rates were 78.7%, 52.4%, and 44.4%, respectively. In the radical surgery group, survival rates were 84%, 75.6%, and 60.6%, respectively, vs. 91.7%, 41.7%, and 20.8% in the endovascular group. In the medical group with persistent infection, survival rates were 37.5% and 0%. The average length of antibiotic treatment was 8 days preoperatively and 3 months postoperatively. Periaortic infectious recurrence was observed in 1 patient.

Conclusion: The combination of medical treatment and radical open surgery is effective in the treatment of IAA. Endovascular treatment yields acceptable results. Medical treatment alone should only be reserved for patients who are inoperable due to a very high short-term mortality.