Outcomes of Management Strategies for Primary Infected Abdominal Aortic Aneurysm: A Single-Center Retrospective Study.

Objectives: To summarize the experience of diagnosing and treating of infrarenal infected native abdominal aortic aneurysm (INAA) by reviewing the clinical characteristics, management strategies, and outcomes of patients in a single center.

Methods: The clinical data of 17 patients with INAA admitted to the Department of Vascular Surgery, Beijing Hospital from April 2017 to October 2024 were retrospectively analyzed. Patient demographics, comorbidities, postoperative complications, long-term survival, re-intervention rates, treatment approaches, and follow-up outcomes were reviewed and summarized.

Results: Of the 17 patients included (94.1% male, mean age 63.4 ± 7.2 years), 52.9% presented with abdominal pain and 58.8% were threatened with aneurysm rupture or fistula formation. Microbial cultures identified Gram-negative bacilli in 82.4% of cases. Four patients received conservative treatment, of whom three died (75%). Thirteen patients underwent surgery: five received open surgical repair (OSR; all survived, 100% survival rate), and eight endovascular aneurysm repairs (EVAR; three died, 62.5% survival rate). The overall mortality rate was 35.3%. The treatment modality may have contributed to the observed differences in survival.

Conclusions: Our results suggest that open surgical repair (OSR) may offer favorable outcomes for selected patients with INAA, while EVAR can be considered for high-risk or emergency cases. Individualized treatment strategies, based on multidisciplinary team (MDT) evaluation and patient characteristics, are essential for optimal care. Given the retrospective design, small sample size, and possible selection bias, these findings are preliminary and hypothesis-generating. Further large-scale, prospective studies are needed to confirm the optimal management of INAA.