In Touma et al.’s recent report, emergency endovascular aneurysm repair (EVAR) for infected native aortic aneurysms (INAAs) led to infection related complications (IRCs) in five of six patients (83%) at a median of seven days, necessitating conversion to open surgery.
1
This rate is higher than reported in a recent systematic review and meta-analysis by the present authors (14% in total, EVAR 2.4 times higher risk)- Touma J.
- Couture T.
- Davaine J.M.
- de Boissieu P.
- Oubaya N.
- Michel C.
- et al.
Mycotic/infective native aortic aneurysms: results after preferential use of open surgery and arterial allografts.
Eur J Vasc Endovasc Surg. 2021; ([Epub ahead of print])https://doi.org/10.1016/j.ejvs.2021.10.041
2
or in another recent review (8%, open repair; 23%, EVAR).3
Their experience highlights the potential inability to control infection using temporising emergency EVAR. Moreover, this leads us to ask what were the IRCs between those able to be treated electively after pre-operative antibiotics (e.g., at least two weeks) and those less optimally (e.g., urgent or less than two weeks) undergoing open surgical repair (n = 64)? This may further suggest proper use of pre-operative antibiotics in INAAs, particularly as pathogens were only identified in 43% pre-operatively. IRCs were only 10% in open repair, yet local septic control methods were not fully described with omentoplasty noted in only 27%. Were other methods used? Realising direct comparison of specific interventional roles is difficult, we thank the authors for sharing their extensive experience.- Han M.
- Wang J.
- Zhao J.
- Ma Y.
- Huang B.
- Yuan D.
- et al.
Systematic review and meta-analysis of outcomes following endovascular and open repair for infective native aortic aneurysms.
Ann Vasc Surg. 2021; ([Epub ahead of print])https://doi.org/10.1016/j.avsg.2021.07.025
References
- Mycotic/infective native aortic aneurysms: results after preferential use of open surgery and arterial allografts.Eur J Vasc Endovasc Surg. 2021; ([Epub ahead of print])https://doi.org/10.1016/j.ejvs.2021.10.041
- Recurrent infection is more common after endovascular versus open repair of infected abdominal aortic aneurysm: systematic review and meta-analysis.J Vasc Surg. 2022; 75: 348-355
- Systematic review and meta-analysis of outcomes following endovascular and open repair for infective native aortic aneurysms.Ann Vasc Surg. 2021; ([Epub ahead of print])https://doi.org/10.1016/j.avsg.2021.07.025
Article info
Publication history
Published online: March 06, 2022
Accepted:
December 24,
2021
Received:
December 18,
2021
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- Mycotic/Infective Native Aortic Aneurysms: Results After Preferential Use of Open Surgery and Arterial AllograftsEuropean Journal of Vascular and Endovascular SurgeryVol. 63Issue 3Open Archive
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