Infected native aortic aneurysms: epidemiology, management, and outcomes based on a nationwide population-based study

Background and Aims Large-scale investigations with longitudinal data on infected native aortic aneurysms (INAAs), a rare but life-threatening emergency, are lacking. The epidemiology, treatment trends, and outcomes of INAAs were investigated in a nationwide population-based cohort. Methods A total of 2387 hospitalisations for INAAs were identified between 2001 and 2021 in the Taiwanese National Health Insurance Research Database. A retrospective cohort was analysed using data spanning a 21-year study period. In-hospital and post-discharge adverse events, including 1-, 3-, 5- and 10-year mortality, were assessed. Results The cohort had a mean age of 73.8 ± 11.8 years, with 77.6% being men. There was an increasing trend in INAAs over time, with a high prevalence of comorbid renal insufficiency (53%). Most patients were treated with third-generation cephalosporins and anti-methicillin-resistant Staphylococcus aureus agents. Conservative treatment was associated with the highest mortality rates, including in-hospital death and post-discharge death. The risk of in-hospital mortality was significantly lower in the endovascular aortic repair (EVAR) group compared with the open repair group [odds ratio 0.76, 95% confidence interval (CI): 0.63–0.91]. At the end of follow-up, patients who underwent EVAR demonstrated high mortality risks (hazard ratio 1.13, 95% CI: 1.04–1.23 at the end of follow-up) than open repair. Conclusions Surgical repair is associated with significantly more favourable post-discharge survival compared with EVAR, underscoring the importance of open repair for optimal management of INAAs. In selected high-risk patients, EVAR may serve as a temporising or palliative option, particularly when definitive open repair is not immediately feasible.