NEW YORK (Reuters Health) – Many patients who undergo repair of mycotic aortic aneurysms die during surgery, with those presenting with rupture at particularly high risk, according to new findings.
“Overall, information about the diagnosis and management of mycotic aortic aneurysms is limited,” Dr. Scott LeMaire of Baylor College of Medicine, in Houston, Texas, told Reuters Health by email. “Nevertheless, our study demonstrates that they are extremely lethal.”
There is no consensus on the optimal management of patients with mycotic aortic aneurysms, which account for less than 1% of all aortic aneurysms, Dr. LeMaire and his colleagues note in a paper the Journal of Thoracic and Cardiovascular Surgery.
Relying on their institution’s prospectively maintained aortic-surgery database, the team took a look back at three decades’ worth of outcomes. They identified 75 patients (median age, 68 years) who underwent surgical repair of a mycotic aortic aneurysm between 1992 and 2021.
Ninety-six percent of patients presented with symptoms, 35% had rupture and 85% underwent urgent repair. Eighty-one percent of patients had open repair, while the remainder had endovascular or hybrid repair.
The database recorded several infection-specific adjunct techniques, including rifampin-soaked grafts (16 patients), omental pedicle flaps (21 patients), and antibiotic irrigation catheters (eight patients).
Twenty percent of the patients died during surgery, include 10 (38%) of the 26 patients who presented with rupture.
Persistent stroke, paraplegia or paraparesis, and renal failure that required dialysis were uncommon (<5%). Eighty-seven percent of the 60 early survivors were discharged on long-term antibiotic therapy. The estimated rates of survival at two years, six years and ten years were 56%, 39% and 27%, respectively.
Dr. LeMaire said it is important to identify these aneurysms early and repair them before rupture occurs, as this could optimize the chance for survival.
“In our experience, we have found that both open and endovascular approaches play a role in treatment of mycotic aortic aneurysms,” he said. “During open operations, we favor thorough removal of all infected aortic tissue and the use of a tissue graft or an antibiotic-soaked synthetic graft to replace the portion of aorta that has been removed.”
Dr. LeMaire added that given the rarity of mycotic aortic aneurysms, additional studies, particularly those “involving several experienced centers, are needed to better understand how to select the best treatment strategy for individual patients.”
The researchers note that they used a “liberal definition” for mycotic aortic aneurysm, which resulted in “a heterogeneous cohort of patients.”
“We hope that our study provides information that will help other surgeons to discuss treatment options and risks with patients and their family members and to determine a suitable management strategy,” Dr. LeMaire said.
SOURCE: https://bit.ly/38U8dTE Journal of Thoracic and Cardiovascular Surgery, online April 7, 2022.
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