Endovascular treatment of mycotic aortic aneurysms: a European multicenter study
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Endovascular treatment of mycotic aortic aneurysms: a European multicenter study. / Sörelius, Karl; Mani, Kevin; Björck, Martin; Sedivy, Petr; Wahlgren, Carl-Magnus; Taylor, Peter; Clough, Rachel E; Lyons, Oliver; Thompson, Matt; Brownrigg, Jack; Ivancev, Krassi; Davis, Meryl; Jenkins, Michael P; Jaffer, Usman; Bown, Matt; Rancic, Zoran; Mayer, Dieter; Brunkwall, Jan; Gawenda, Michael; Kölbel, Tilo; Jean-Baptiste, Elixène; Moll, Frans; Berger, Paul; Liapis, Christos D; Moulakakis, Konstantinos G; Langenskiöld, Marcus; Roos, Håkan; Larzon, Thomas; Pirouzram, Artai; Wanhainen, Anders; European MAA collaborators.
in: CIRCULATION, Jahrgang 130, Nr. 24, 09.12.2014, S. 2136-2142.Publikationen: SCORING: Beitrag in Fachzeitschrift/Zeitung › SCORING: Zeitschriftenaufsatz › Forschung › Begutachtung
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TY - JOUR
T1 - Endovascular treatment of mycotic aortic aneurysms: a European multicenter study
AU - Sörelius, Karl
AU - Mani, Kevin
AU - Björck, Martin
AU - Sedivy, Petr
AU - Wahlgren, Carl-Magnus
AU - Taylor, Peter
AU - Clough, Rachel E
AU - Lyons, Oliver
AU - Thompson, Matt
AU - Brownrigg, Jack
AU - Ivancev, Krassi
AU - Davis, Meryl
AU - Jenkins, Michael P
AU - Jaffer, Usman
AU - Bown, Matt
AU - Rancic, Zoran
AU - Mayer, Dieter
AU - Brunkwall, Jan
AU - Gawenda, Michael
AU - Kölbel, Tilo
AU - Jean-Baptiste, Elixène
AU - Moll, Frans
AU - Berger, Paul
AU - Liapis, Christos D
AU - Moulakakis, Konstantinos G
AU - Langenskiöld, Marcus
AU - Roos, Håkan
AU - Larzon, Thomas
AU - Pirouzram, Artai
AU - Wanhainen, Anders
AU - European MAA collaborators
N1 - © 2014 American Heart Association, Inc.
PY - 2014/12/9
Y1 - 2014/12/9
N2 - 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-Salmonella-positive blood cultures were more likely to die from late infection.
AB - 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-Salmonella-positive blood cultures were more likely to die from late infection.
KW - Adult
KW - Aged
KW - Aged, 80 and over
KW - Aneurysm, Infected/epidemiology
KW - Anti-Bacterial Agents/therapeutic use
KW - Aortic Aneurysm/epidemiology
KW - Endovascular Procedures/methods
KW - Europe/epidemiology
KW - Feasibility Studies
KW - Female
KW - Follow-Up Studies
KW - Humans
KW - Incidence
KW - Male
KW - Middle Aged
KW - Regression Analysis
KW - Retrospective Studies
KW - Surgical Wound Infection/epidemiology
KW - Survival Rate
KW - Time Factors
KW - Treatment Outcome
U2 - 10.1161/CIRCULATIONAHA.114.009481
DO - 10.1161/CIRCULATIONAHA.114.009481
M3 - SCORING: Journal article
C2 - 25378548
VL - 130
SP - 2136
EP - 2142
JO - CIRCULATION
JF - CIRCULATION
SN - 0009-7322
IS - 24
ER -