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Semi-conservative Treatment for Aortic Infection
OBJECTIVE
Aortic infection (AI) is a serious condition that usually is considered to require radical open surgery. EVAR and other semi-conservative options are traditionally regarded as bridging procedures. Radical open surgery, however, is associated with significant risks. The aim of this study was to assess the safety of the less invasive "semi-conservative" approach to AI.
METHODS
Forty-four patients with AI, including 13 primary mycotic aneurysms, 13 graft infections, and 18 stent-graft infections were included in this retrospective study.
"Semi-conservative approach" was defined as: 1) translumbar drainage of an infected aortic sac after EVAR, 2) EVAR of a mycotic aneurysm, anastomotic insufficiency or a fistula 3) resection of an infected sac after EVAR leaving behind the stent-graft and 4) antibiotic treatment alone.
Staphylococcus aureus was identified in 23% of cases and coagulase negative staphylococci in 6%, but a broad range of other bacteria was also present.
Type and efficacy of "semi-conservative" treatment was assessed. Median follow up time was 2.7yrs (17d-7.3yrs).
RESULTS
Stent-graft infections were treated with drainage (5), debridement (4), EVAR (4), and antibiotics alone (5). All 13 mycotic aneurysms and 10 graft infections were treated with EVAR.
30-day mortality after semi-conservative treatment was 7%.
27 % of patients needed additional re-interventions at 3mo (7d-2yrs). The re-interventions were also semi-conservative except in two patients (5.5%) who required radical surgery.
There were 15 infection related deaths (34%) at 5mo (8d-4.75yrs): 7 (39%) of the stent-graft infections, 6 (46%) of graft infections, and 2 (15%) of mycotic aneurysms.
24 patients survive at 2.7yrs (17d-7.3yrs). 5 patients died of infection unrelated causes.
Fifty-two percent of patients with secondary AI had multiple vascular procedures prior to their infection. Treatment was initiated 23mo (1mo - 30 yrs) after the last vascular procedure.
CONCLUSIONS
Semi-conservative treatment is a less traumatic approach to AI with a low 30-day mortality and acceptable mid term survival, especially for primary mycotic aneurysms. Reinterventions are needed in a third of the cases but are also predominantly semi-conservative while radical surgery can be avoided.