Mycotic Abdominal Aortic Aneurysms – A Tertiary Centre Experience and Formulation of a Management Protocol

Autor: S Premnath, Aurelien Hostalery, T Rowlands, Vasudev Zaver, Sanjay Singh, John W. Quarmby
Rok vydání: 2021
Předmět:
Male
medicine.medical_specialty
Time Factors
Clinical Decision-Making
030204 cardiovascular system & hematology
Risk Assessment
Decision Support Techniques
030218 nuclear medicine & medical imaging
Tertiary Care Centers
Blood Vessel Prosthesis Implantation
03 medical and health sciences
Aortic aneurysm
Postoperative Complications
0302 clinical medicine
Clinical Protocols
Risk Factors
Antibiotic therapy
medicine
Overall survival
Humans
Survival analysis
Aged
Retrospective Studies
Aged
80 and over
Protocol (science)
business.industry
General surgery
Endovascular Procedures
Significant difference
General Medicine
Middle Aged
medicine.disease
Combined Modality Therapy
Progression-Free Survival
Anti-Bacterial Agents
Log-rank test
Female
Surgery
Outcome data
Cardiology and Cardiovascular Medicine
business
Aneurysm
Infected
Aortic Aneurysm
Abdominal
Zdroj: Annals of Vascular Surgery. 74:246-257
ISSN: 0890-5096
Popis: Background Mycotic abdominal aorta aneurysm (MAAA) is a rare and life-threatening condition. Because of its rarity, there is a lack of adequately powered studies and consensus on its treatment and follow up. This study aimed to review the outcomes following surgical intervention for MAAA in a single tertiary centre and to formulate a management protocol based on available evidence and expert opinion. Materials and Methods Data were collected by retrospective review of case records of all patients who underwent repair of MAAA in a single tertiary referral centre from 2001 to 2018. Demographic, clinical and outcome data were analysed and compared with previously published series in the literature. A management protocol was formulated based on available literature which was then reviewed and modified as per expert opinion from multidisciplinary discussions. Results Seventeen patients underwent repair of MAAA during the study period including 4 Open repairs, 4 surgeon modified fenestrated endovascular aortic aneurysm repairs (SM FEVAR) and 9 endovascular aortic aneurysm repairs (EVAR). One-year overall survival was 94.1%, 3-year survival was 81.8% and 5-year survival was 75.0%. The infection-free survival at 1, 3, and 5 years was 87.5%, 81.8% and 62.5%, respectively. The overall survival and infection-free survival curves for Open repair, EVAR and SM FEVAR when compared using Log Rank (Mantel-Cox) test and did not show any statistically significant difference. Conclusions Management of MAAA with selective use of open or endovascular repair, in combination with appropriate long-term antibiotic therapy, can achieve acceptable outcomes. The proposed protocol can aid as a guiding document for the management of MAAA but needs taking into consideration individual patient variability and local expertise.
Databáze: OpenAIRE
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