[Mycotic aortic aneurysm-Representative cases : Case series of clinical case examples and the current literature on the treatment options of open surgical resection with prosthesis implantation (OR) and endovascular aortic repair (EVAR)].

Abstract

Background: The mycotic aortic aneurysm (MAA) is a rare life-threatening condition. Treatment options include open surgical resection (OR) with prosthesis implantation and endovascular aortic repair (EVAR).

Aim: Presentation of the therapeutic decisions illustrated by clinical case examples and discussion of current references from the medical scientific literature.

Case reports: 1. An emergency resection of a covered ruptured abdominal aortic aneurysm (AAA) in a 74-year-old female patient revealed a MAA. A xenograft was implanted. Ultimately, the comorbidities led to death. 2. A 79-year-old male patient with a MAA as the focus of a Salmonella sepsis underwent EVAR using implantation of a stent graft. Correct graft placement and adequate perfusion were confirmed. On postoperative day 7, the patient was discharged with long-term antibiotic therapy. 3. A 63-year-old male patient with a covered ruptured AAA and psoas muscle abscess underwent emergency surgery with OR and implantation of a xenograft prosthesis. On postoperative day 12 the patient was discharged with long-term antibiotic therapy.

Discussion: An analysis of 21 studies (2433 patients) showed a better short-term survival using EVAR (3-month survival, 96% vs. 74% for OR) but a higher reinfection rate (42 % vs. 18 %). The 5‑year survival rates are similar (EVAR: 57-79.7%, OR: 60%). The most common pathogens were Salmonella (26.3%) and Staphylococcus aureus (13.9%). Blood cultures remained negative in 37.4%. Risk factors are advanced age, male gender and comorbidities. A long-term antibiotic therapy of > 6 months improves the outcome.

Conclusion: The treatment of MAA requires an individualized approach as both OR and EVAR exhibit similar long-term outcomes but different early complication rates. Long-term antibiotic therapy is essential for an optimal outcome.