Is endovascular repair of mycotic aortic aneurysms a durable treatment option?

Eur J Vasc Endovasc Surg. 2009 Apr;37(4):407-12. doi: 10.1016/j.ejvs.2008.11.025. Epub 2009 Feb 10.


Objective: Endovascular repair for degenerative aortic aneurysms is well established, but its role in those with infective pathology remains controversial. This study aims to assess the durability of endovascular repair with a review of our midterm results.

Method: A retrospective analysis of a prospectively maintained endovascular database (1998-2008) was conducted, which identified 673 consecutive patients with aortic aneurysms.

Results: Nineteen patients (2.8%) were identified with infected aortic aneurysms, in which there were a total of 23 separate aneurysms (16 thoracic and seven abdominal). Six patients (32%) presented with rupture. Eleven patients (58%) had received antibiotics preoperatively for a median duration of 11 days (1-54 days). Fifteen of the 19 (79%) had positive blood cultures, with Staphylococcus aureus being the most common organism. All 19 patients underwent endovascular repair. There were three Type I endoleaks (one requiring conversion to open repair) and two Type II endoleaks. One patient developed transient paraplegia, resolved by cerebrovascular fluid (CSF) drainage, and one patient had a stroke. The 30-day mortality was 11%, and survival at median follow-up of 20 months (0-83 months) was 73%. All eight deaths in the series were related to aneurysm.

Conclusion: Endovascular treatment of infective aortic pathology provides an early survival benefit; however, concerns over on-going graft infection remain.

MeSH terms

  • Adult
  • Aged
  • Aneurysm, Infected / diagnostic imaging
  • Aneurysm, Infected / microbiology
  • Aneurysm, Infected / mortality
  • Aneurysm, Infected / surgery*
  • Anti-Bacterial Agents / therapeutic use
  • Aortic Aneurysm, Abdominal / diagnostic imaging
  • Aortic Aneurysm, Abdominal / mortality
  • Aortic Aneurysm, Abdominal / surgery*
  • Aortic Aneurysm, Thoracic / diagnostic imaging
  • Aortic Aneurysm, Thoracic / mortality
  • Aortic Aneurysm, Thoracic / surgery*
  • Aortic Rupture / diagnostic imaging
  • Aortic Rupture / mortality
  • Aortic Rupture / surgery
  • Blood Vessel Prosthesis*
  • Female
  • Fistula / diagnostic imaging
  • Fistula / surgery
  • Humans
  • Male
  • Middle Aged
  • Postoperative Complications
  • Prospective Studies
  • Radiography
  • Retrospective Studies
  • Staphylococcus aureus / isolation & purification
  • Stents*
  • Treatment Outcome


  • Anti-Bacterial Agents