Mycotic aortic arch aneurysms: Open versus endovascular management – An institutional experience

Abstract

Background: Mycotic aortic aneurysms are rare disorders, affecting patients with co-morbidities, and associated with a high risk of aneurysm expansion, rupture, and sepsis. Aims and Objectives: In this study, we present our experience on the management of patients with mycotic arch aneurysms. Materials and Methods: From January 2020 till July 2023, eight patients were admitted in our hospital for management of mycotic aortic arch aneurysm. On a case-to-case basis, the management was selected for each patient and consent was taken for the same. Results: Four patients underwent open repair and four endovascular repair, out of which three underwent hybrid arch repair. While only one patient in the open group expired in the immediate postoperative period due to sepsis, the remaining patients have been on follow-up for 1month-1year. There was no mortality in the immediate post TEVAR period. However, three of the patients who underwent TEVAR required re-admissions and re-intervention, with one patient developing aorto-esophageal fistula. Two of these patients expired in a span of 3months-1.5years post TEVAR. Conclusion: In patients with mycotic arch aneurysm, open surgical repair should be the modality of choice in fit surgical patients and endovascular management can be used as a bridge therapy, keeping in mind the risks of residual infection in the aorta which can lead to re-interventions and re-admissions.

Keywords

• mycotic aneurysm
• mycotic arch aneurysm
• open surgical repair
• thoracic endovascular aortic repair bridge therapy