Outcomes of emergency endovascular repair for ruptured mycotic aortic aneurysm

Abstract

Background: Ruptured mycotic aortic aneurysm (RMAA) is the life-threatening complication of a rare infectious disease, mycotic aortic aneurysm (MAA). This condition requires emergency aortic repair traditionally performed by open surgery, but the results of this technique are mediocre with peri-operative mortality up to 63%. It has been recently reported that endovascular aortic repair (EVAR) has better results than open surgery for non ruptured MAA, showing less mortality and morbidity. However, the results of EVAR for ruptured MAA are still poorly documented at this date. This retrospective study is the first to review technical success, in-hospital survival, and mid-term outcomes of emergency EVAR as a treatment for RMAA. Methods: We retrospectively included nine patients (median age 71 years; range 57–87) treated between June 2014 and September 2022 by emergency EVAR for RMAA and adjunctive antibiotic therapy. Demographics, clinical presentations, laboratory results, technical success, in-hospital survival and mid-term outcomes of these patients were reviewed. Results: All the patients underwent successful emergency EVAR with correct endograft placement and complete aneurysm exclusion. Positive microbial cultures were obtained in 8 patients. The median follow-up duration is 29 months (range, 1–60 mo). The in-hospital mortality rate was 22% (2/9), fistulization in the esophagus or bronchus was associated with in-hospital death. The 1-year survival rate was 67% (6/9). They were no late reinfection of the endograft during follow-up. Conclusions: EVAR is a promising alternative to open surgery for RMAA treatment. Our study shows good short and mid-term outcomes, and absence of reinfection. However, more studies are still needed to compare EVAR versus open surgery.