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Nationwide Study on Treatment of Mycotic Thoracic Aortic Aneurysms.
Sörelius, Karl; Wanhainen, Anders; Wahlgren, Carl-Magnus; Langenskiöld, Marcus; Roos, Håkan; Resch, Timothy; Vaccarino, Roberta; Arvidsson, Bengt; Gillgren, Peter; Bilos, Linda; Pirouzram, Artai; Holsti, Mari; Mani, Kevin.
Afiliación
  • Sörelius K; Department of Surgical Sciences Section of Vascular Surgery, Uppsala University, Uppsala, Sweden. Electronic address: karlsorelius@hotmail.com.
  • Wanhainen A; Department of Surgical Sciences Section of Vascular Surgery, Uppsala University, Uppsala, Sweden.
  • Wahlgren CM; Department of Vascular Surgery, Karolinska Hospital, Stockholm, Sweden.
  • Langenskiöld M; Unit of Vascular Surgery, Department of Hybrid and Interventional Surgery, Sahlgrenska University Hospital, Gothenburg, Sweden.
  • Roos H; Unit of Vascular Surgery, Department of Hybrid and Interventional Surgery, Sahlgrenska University Hospital, Gothenburg, Sweden.
  • Resch T; Vascular Centre, Skåne University Hospital, Malmö, Sweden.
  • Vaccarino R; Vascular Centre, Skåne University Hospital, Malmö, Sweden.
  • Arvidsson B; Department of Thoracic and Vascular Surgery, Linköping University, Linköping, Sweden; Department of Medical and Health Sciences, Linköping University, Linköping, Sweden.
  • Gillgren P; Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden; Unit for Vascular Surgery, Department of Surgery, Södersjukhuset, Stockholm, Sweden.
  • Bilos L; Department of Cardiothoracic and Vascular Surgery, Faculty of Medicine and Vascular Surgery, Örebro University Hospital, Örebro, Sweden.
  • Pirouzram A; Department of Cardiothoracic and Vascular Surgery, Faculty of Medicine and Vascular Surgery, Örebro University Hospital, Örebro, Sweden.
  • Holsti M; Department of Surgical and Peri-operative Sciences, Surgery, Umeå University Hospital, Umeå, Sweden.
  • Mani K; Department of Surgical Sciences Section of Vascular Surgery, Uppsala University, Uppsala, Sweden.
Eur J Vasc Endovasc Surg ; 57(2): 239-246, 2019 Feb.
Article en En | MEDLINE | ID: mdl-30340857
OBJECTIVE: Mycotic aortic aneurysms are rare, life threatening, and complex. This nationwide study aimed to assess outcome after repair of mycotic thoracic aortic aneurysms (MTAAs). METHODS: Patients treated in Sweden for MTAAs between 2000 and 2016 were identified in the Swedish vascular registry (2010-16) and local patient registries (2000-09). Primary outcome was survival, and secondary outcomes included surgical strategy, rate of infection related complications (IRC), and re-operations. RESULTS: Fifty-two patients (median age 71 ± 8.1 years; 28 [54%] men, 13 [25%] ruptured) were identified (3.6% of all thoracic aortic aneurysm repairs in Sweden). Aneurysm location was aortic arch (n = 6; 11%), descending aorta (n = 42; 81%), and multiple locations (n = 4; 8%). Twenty-nine (56%) patients had positive cultures; the most prevalent agent was Staphylococcus aureus (n = 16; 31%). Operative techniques included thoracic endovascular aortic repair (TEVAR; n = 35 [67%]), fenestrated/branched TEVAR (n = 8; 15%), hybrid repair (n = 7; 14%), and open patch repair (n = 2; 4%). Survival was 92% (95% confidence interval [CI] 88-96) at 30 days, 88% (95% CI 84-93) at three months, 78% (73-84) at one year, and 71% (64-77) at five years. The mean follow up among survivors (> 90 days) was 45 months (range 4-216 months). Antibiotics were administered for a median of 15 weeks (range 0-220 weeks). IRCs occurred in nine patients (17%): sepsis (n = 3), graft infection (n = 3), recurrent mycotic aneurysm (n = 1), aorto-oesophageal/bronchial fistula (n = 2). Six (67%) IRCs were fatal; 80% occurred within the first year. Re-operations were performed in nine patients (17%). CONCLUSIONS: TEVAR was often used as treatment for MTAAs, with acceptable short- and long-term survival when compared with open cohorts in the literature. IRCs are of concern and warrant follow up and long-term antibiotic treatment.
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Rotura de la Aorta / Infecciones Estafilocócicas / Aneurisma Infectado / Aneurisma de la Aorta Torácica / Procedimientos Endovasculares Tipo de estudio: Observational_studies / Risk_factors_studies Límite: Aged / Aged80 / Female / Humans / Male / Middle aged País/Región como asunto: Europa Idioma: En Revista: Eur J Vasc Endovasc Surg Asunto de la revista: ANGIOLOGIA Año: 2019 Tipo del documento: Article Pais de publicación: Reino Unido
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Rotura de la Aorta / Infecciones Estafilocócicas / Aneurisma Infectado / Aneurisma de la Aorta Torácica / Procedimientos Endovasculares Tipo de estudio: Observational_studies / Risk_factors_studies Límite: Aged / Aged80 / Female / Humans / Male / Middle aged País/Región como asunto: Europa Idioma: En Revista: Eur J Vasc Endovasc Surg Asunto de la revista: ANGIOLOGIA Año: 2019 Tipo del documento: Article Pais de publicación: Reino Unido