Endovascular Treatment of Mycotic Aortic and Iliac Aneurysms in a Tertiary Center: A 15-Year Experience

Abstract

Objective This retrospective case series reports the 15-year experience of the endovascular management of mycotic aortic and iliac aneurysms (MAAs) at a tertiary referral center in the United Kingdom.

Materials and Methods The patients were identified through advanced searches in picture archiving and communication system (PACS) and electronic patient records. Data were retrieved and recorded in a structured spreadsheet including demographic details, symptoms and comorbidities, endovascular techniques employed and graft types, as well as treatment outcomes including 30-day mortality, 1-, 3-, and 5-year survival, aneurysm resolution percentage, and rates of re-intervention and complications.

Statistical Analysis Descriptive statistics summarized the demographic and clinical characteristics, presenting them as means for continuous variables and frequencies/percentages for categorical variables.

Results Of the 15 included patients, 73.3% (11/15) and 26.7% (4/15) were males and females, respectively, with a mean age of 64 years. Imaging revealed diverse anatomical involvement, with MAA in the descending thoracic (6/15), suprarenal and juxtarenal (5/15), infrarenal (3/15), and common iliac arteries (1/15). The 30-day mortality rate was 6.7% (1/15), while 1-, 3-, and 5-year survival rates from time of initial intervention were 57.1% (8/14), 38.5% (5/13), and 30.8% (4/13), respectively, with 1 case only just having undergone 1-month follow-up (performed in July 2023). The average mycotic aneurysm size was 47 mm (range: 19–80 mm), of which 33.3% (5/15) presented with rupture. The average sac size reduction following treatment was 31%, with 5/15 cases demonstrating complete resolution. Four cases required re-intervention due to persistent endoleak, sac re-expansion secondary to delayed endoleak, or stent occlusion. Persistent or recurrent graft infection was observed in 53.3% (8/15) of cases. Two cases required surgical re-intervention for stent occlusion.

Conclusion Our findings reinforce the role of endovascular interventions in MAA acute management, showcasing immediate survival benefits. Late complications and frequent re-interventions emphasize the importance of vigilant surveillance.

Keywords

endovascular - aortic aneurysm - mycotic - aortic graft

Note

The article was presented earlier at PAIRS 2024, Dubai, February 2024.

Ethical Approval Statement

An institutional review board approval by the Clinical Effectiveness unit at the Trust was secured before initiating the data collection process.

Authors' Contribution

I.T., M.R.A., and A.E. conceived the research idea and designed the study. I.T. gathered the data, performed the statistical analysis of the data, and drafted the initial manuscript. O.J., M.M., D.L., I.R., M.R.A., and A.E. provided critical revisions and intellectual input and supervised the overall research process. All authors reviewed and approved the final version of the manuscript.

Publication History

Article published online:
11 July 2024

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