European Study Evaluates EVAR Treatment of Mycotic Aortic Aneurysms

December 9, 2014—Results from a European multicenter study of endovascular aneurysm repair (EVAR) of mycotic aortic aneurysms (MAAs) were published by Karl Sörelius, MD, et al for the European MAA collaborators in Circulation (2014;130:2136–2140). The aim of the study was to evaluate the durability of EVAR for MAAs by assessing late infection-related complications and long-term survival.

The investigators concluded that endovascular treatment of MAAs—a rare, life-threatening disease—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-Salmonella-positive blood cultures were more likely to die from late infection, noted the investigators in Circulation.

In the study, the investigators retrospectively reviewed all EVAR-treated MAAs at 16 centers between 1999 and 2013 at 16 European centers. They identified 123 patients with 130 MAAs. The mean patient age was 69 years (range, 39–86), 87 patients (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). The treatments used were thoracic EVAR (n = 43), fenestrated/branched EVAR (n = 9), and infrarenal EVAR (n = 71). Antibiotics were administered for a mean of 30 weeks. 

As summarized in Circulation, the 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%–96%), 75% (67%–83%), 55% (44%–66%), and 41% (28%–54%) at 1, 12, 60, and 120 months, respectively. Infection-related death occurred in 23 patients (19%), nine after discontinuation of antibiotic treatment. A Cox regression analysis demonstrated non-Salmonella-positive cultures as predictors for late infection-related death, reported the investigators.