Therapeutic Opinion on Endovascular Repair for Mycotic Aortic Aneurysm

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• 作者：Yao-Kuang Huang¹ ; ² ; ³ ; Po-Jen Ko² ; Chyi-Liang Chen⁴ ; Feng-Chun Tsai² ; Chi-Hsiung Wu¹ ; Pyng Jing Lin² ; Cheng-Hsun Chiu³ ; ⁴ ; ^{huang137@mac.com" class="auth_mail}
• 刊名：Annals of Vascular Surgery
• 出版年：April, 2014
• 年：2014
• 卷：28
• 期：3
• 页码：579-589
• 全文大小：717 K

文摘

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Background

Our aim in this study was to assess the feasibility of endovascular repair for mycotic aortic aneurysms (MAAs) and to provide a therapeutic opinion.

Methods

We retrospectively reviewed the records of 12 patients who underwent endovascular repair for MAAs between September 2006 and June聽2011.

Results

Patients consisted of 9 men and 3 women, with a median age of 64.6聽years (range 45-75聽years). The aortic aneurysms were in the thoracic/thoracoabdominal aorta in 5 patients, juxtarenal aorta with visceral involvement in 2 patients, and infrarenal abdominal aorta in 5 patients. Blood cultures of 10 patients (83.3%) were positive for bacteria and showed Salmonella species (8聽patients), Klebsiella pneumonia (1 patient), and Escherichia coli (1 patients). Eight patients with active sepsis or active bleeding underwent emergent endovascular repair because of unstable hemodynamics. Notably, 2 patients required adjuvant surgery for complete removal of infectious foci. No deaths occurred within 30聽days after intervention. We recorded 2 late deaths: 1 patient died of progressive pneumonia on day 39 after intervention and the other died of liver failure on day 58 after intervention. Late complications were observed in 3 patients, 1 of whom needed an aortic revision for late prosthesis infection. The mean follow-up time was 24聽卤聽19.7聽months.

Conclusions

Endovascular repair is a feasible therapeutic option for MAAs in that it can both stop bleeding and exclude the aneurysms. Although the aortic interventions performed were successful, the patients had an immunocompromised status and a difficult postoperative recovery. 鈥淎ggressive鈥?surgical drainage may be necessary in some patients and may lead to a better outcome.