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 |
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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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