Endovascular Treatment of Mycotic Aortic Aneurysms A European Multicenter Study

被引:197
|
作者
Sorelius, Karl [1 ]
Mani, Kevin [1 ]
Bjorck, Martin [1 ]
Sedivy, Petr [2 ]
Wahlgren, Carl-Magnus [3 ]
Taylor, Peter [4 ]
Clough, Rachel E. [4 ]
Lyons, Oliver [4 ]
Thompson, Matt [5 ]
Brownrigg, Jack [5 ]
Ivancev, Krassi [6 ]
Davis, Meryl [6 ]
Jenkins, Michael P. [7 ]
Jaffer, Usman [7 ]
Bown, Matt [8 ,9 ]
Rancic, Zoran [10 ]
Mayer, Dieter [10 ]
Brunkwall, Jan [11 ]
Gawenda, Michael [11 ]
Koelbel, Tilo [12 ]
Jean-Baptiste, Elixene [13 ]
Moll, Frans [14 ]
Berger, Paul [14 ]
Liapis, Christos D. [15 ]
Moulakakis, Konstantinos G. [15 ]
Langenskiold, Marcus [16 ]
Roos, Hakan
Larzon, Thomas [17 ]
Pirouzram, Artai [17 ]
Wanhainen, Anders [1 ]
机构
[1] Uppsala Univ, Dept Vasc Surg, Inst Surg Sci, SE-75185 Uppsala, Sweden
[2] Na Homolce Hosp, Dept Vasc Surg, Prague, Czech Republic
[3] Karolinska Hosp, Dept Vasc Surg, S-10401 Stockholm, Sweden
[4] Guys & St Thomas Hosp, Dept Vasc Surg, London SE1 9RT, England
[5] St Georges Vasc Inst, London, England
[6] Royal Free London NHS Fdn Trust, Dept Vasc Surg, London, England
[7] Imperial Coll Healthcare NHS Trust, Reg Vasc Unit, St Marys Hosp, London, England
[8] Univ Leicester, Dept Cardiovasc Sci, Leicester, Leics, England
[9] Univ Leicester, NIHR Leicester Cardiovasc Biomed Res Unit, Leicester, Leics, England
[10] Univ Zurich Hosp, Clin Cardiovasc Surg, CH-8091 Zurich, Switzerland
[11] Univ Cologne, Dept Vasc Surg, D-50931 Cologne, Germany
[12] Univ Hosp Eppendorf Hamburg, Univ Heart Ctr, Dept Vasc Med, Hamburg, Germany
[13] Univ Nice Sophia Antipolis, Div Vasc Surg, F-06189 Nice, France
[14] Univ Med Ctr Utrecht, Dept Vasc Surg, Utrecht, Netherlands
[15] Attikon Univ Hosp, Dept Vasc Surg, Athens, Greece
[16] Sahlgrens Univ Hosp, Dept Vasc Surg, Gothenburg, Sweden
[17] Orebro Univ Hosp, Dept Cardiothorac & Vasc Surg, Orebro, Sweden
基金
英国医学研究理事会;
关键词
aneurysm; aorta; infection; surgery; TERM-FOLLOW-UP; ABDOMINAL-AORTA; ILIAC ARTERIES; INFECTED ANEURYSM; THORACIC AORTA; REPAIR; EXPERIENCE; POPULATION; SALMONELLA; SURVIVAL;
D O I
10.1161/CIRCULATIONAHA.114.009481
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Background-Mycotic aortic aneurysm (MAA) is a rare and life-threatening disease. The aim of this European multicenter collaboration was to study the durability of endovascular aortic repair (EVAR) of MAA, by assessing late infection-related complications and long-term survival. Methods and Results-All EVAR treated MAAs, between 1999 and 2013 at 16 European centers, were retrospectively reviewed. One hundred twenty-three patients with 130 MAAs were identified. Mean age was 69 years (range 39-86), 87 (71%) were men, 58 (47%) had immunodeficiency, and 47 (38%) presented with rupture. Anatomic locations were ascending/arch (n=4), descending (n=34), paravisceral (n=15), infrarenal aorta (n=63), and multiple (n=7). Treatments were thoracic EVAR (n=43), fenestrated/branched EVAR (n=9), and infrarenal EVAR (n=71). Antibiotic was administered for mean 30 weeks. Mean follow-up was 35 months (range 1 week to 149 months). Six patients (5%) were converted to open repair during follow-up. Survival was 91% (95% confidence interval, 86% to 96%), 75% (67% to 83%), 55% (44% to 66%), and 41% (28% to 54%) after 1, 12, 60, and 120 months, respectively. Infection-related death occurred in 23 patients (19%), 9 after discontinuation of antibiotic treatment. A Cox regression analysis demonstrated non-Salmonella-positive culture as predictors for late infection-related death. Conclusions-Endovascular treatment of MAA is feasible and for most patients a durable treatment option. Late infections do occur, are often lethal, and warrant long-term antibiotic treatment and follow-up. Patients with non-Salmonellapositive blood cultures were more likely to die from late infection.
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页码:2136 / +
页数:8
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