Management of infectious aortic aneurysms: Short- and mid-term outcomes.

Background: Infectious aortic aneurysms (IAA) are a rare but life-threatening condition due to their rapid development. Their management is multidisciplinary. The main purpose of this study was to evaluate the mortality of patients treated for AIA by different types of treatments. Secondary objectives were to evaluate infectious recurrences and the factors influencing mortality with this management.

Material And Methods: Between September 2009 and October 2023, all the patients with an AIA confirmed by the clinical, biological, microbiological, radiological, and nuclear medicine data were included. Standard treatment included pre- and postoperative antibiotics and open radical surgery with reconstruction using biological material. Endovascular treatment was used in patients with contraindication to open surgery. An alternative "bridge" technique was proposed in emergencies and consisted of the placement of a covered stentgraft followed by secondary open surgical reconstruction. The clinical, biological, bacteriological and imaging data were collected in the REPIA registry, with a 30-day, 1-year and 3-year evaluation. Infectious recurrences were studied.

Results: AIA diagnosis was confirmed in 47 patients with a mean age of 67±10.8 years. Aneurysms were located in the arch (4%), the descending thoracic aorta (21%), the thoracoabdominal aorta (30%), the juxta-renal (4%), and the infrarenal abdominal (41%) aorta. The involved microorganisms were methicilline-sensitive S. aureus (43%), Salmonella (13%), E. coli (9%) and other species (35%). Radical surgery was performed in 27 patients (57.4%): bovine pericardial tubular xenografts and cryopreserved allografts were used in 22 and three cases, respectively. Endovascular treatment was performed in 12 patients (25.5%) Medical treatment only was used in eight cases (17%). The overall 30-day, one-year and three-years survival rates were 78.7%, 52.4% and 44.4%, respectively. In the radical surgery group, survival rates were 84%, 75.6% and 60.6%, respectively, vs. 91.7%, 41.7% and 20.8% in the endovascular group. In the medical group with persistent infection, survival rates were 37.5% and 0%. The average length of antibiotic treatment was eight days preoperatively, and 3 months postoperatively. Peri-aortic infectious recurrence was observed in one patient.

Conclusion: The combination of medical treatment and radical open surgery is effective in the treatment of AIA. Endovascular treatment yields acceptable results. Medical treatment alone should only be reserved for patients who are inoperable due to a very high short-term mortality.