Nationwide Study of the Treatment of Mycotic Abdominal Aortic Aneurysms Comparing Open and Endovascular Repair

• DOI: 10.1161/circulationaha.116.024021
• Publication Date: 2016-11-01T01:11:25Z
• Authors: Karl Sörelius; Anders Wanhainen; Mia Furebring; Martin Björck; Peter Gillgren; Kevin Mani; David Lindström; Rebecka Hultgren; Carl-Magnus Wahlgren; Håkan Roos; Marcus Langenskiöld; Timothy Resch; Roberta Vaccarino; Linda Bilos; Artai Pirouzram; Conny Arnerlöv; Gabor Simo; Mats Svensson; Johan Magnusson; Håkan Astrand; Nils-Peter Gilgen; Stefan Mellander; David Korman; Khatereh Djavani-...; Markus Palm; Mårten Huss; Adam Bertszel; Michael Docter; Christer Drott; Andreas Öjersjö; Olle Nelzén; Tomas Wetterling; Ming Chu
• Keywords: Endovascular aneurysm repair

No reliable comparative data exist between open repair (OR) and endovascular aneurysm (EVAR) for mycotic abdominal aortic aneurysms (MAAAs). This nationwide study assessed outcomes after OR EVAR MAAA in a population-based cohort.All patients treated MAAAs Sweden 1994 2014 were identified the Swedish vascular registry. The primary aim was to assess survival with EVAR. Secondary aims analyses of rate recurrent infections reoperations, time trends surgical treatment. Survival analyzed using Kaplan-Meier log-rank tests. A propensity score-weighted correction risk factor differences 2 groups performed, including operation year account treatment over time.We 132 (0.6% all operated Sweden). Mean age 70 years (standard deviation, 9.2), 50 presented rupture. at 3 months 86% (95% confidence interval, 80%-92%), 1 79% (72%-86%), 5 59% (50%-68%). preferred operative technique shifted from 2001 (proportion 1994-2000 0%, 2001-2007 58%, 2008-2014 60%). Open performed 62 (47%): resection extra-anatomic bypass (n=7), situ reconstruction (n=50), patch plasty (n=3); died intraoperatively. (53%): standard (n=55), fenestrated/branched (n=8), visceral deviation stent grafting (n=7); no deaths occurred lower than (74% versus 96%, P<0.001), similar trend present (73% 84%, P=0.054). risk-adjusted analysis confirmed early better associated During median follow-up 36 41 EVAR, respectively, there difference long-term (5 60% P=0.771), infection-related complications (18% 24%, P=0.439), or reoperation (21% P=0.650).This demonstrates paradigm shift Sweden, being modality. improved short-term comparison OR, without higher incidence serious reoperations.