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Background <p>The mycotic aortic aneurysm (MAA) is a&#xa0;rare life-threatening condition. Treatment options include open surgical resection (OR) with prosthesis implantation and endovascular aortic repair (EVAR).</p> Aim <p>Presentation of the therapeutic decisions illustrated by clinical case examples and discussion of current references from the medical scientific literature.</p> Case reports <p>1.&#xa0;An emergency resection of a covered ruptured abdominal aortic aneurysm (AAA) in a&#xa0;74-year-old female patient revealed a MAA. A&#xa0;xenograft was implanted. Ultimately, the comorbidities led to death. 2.&#xa0;A&#xa0;79-year-old male patient with a MAA as the focus of a&#xa0;<i>Salmonella</i> sepsis underwent EVAR using implantation of a&#xa0;stent graft. Correct graft placement and adequate perfusion were confirmed. On postoperative day&#xa0;7, the patient was discharged with long-term antibiotic therapy. 3.&#xa0;A&#xa0;63-year-old male patient with a&#xa0;covered ruptured AAA and psoas muscle abscess underwent emergency surgery with OR and implantation of a&#xa0;xenograft prosthesis. On postoperative day&#xa0;12 the patient was discharged with long-term antibiotic therapy.</p> Discussion <p>An analysis of 21&#xa0;studies (2433 patients) showed a&#xa0;better short-term survival using EVAR (3-month survival, 96% <i>vs</i>.&#xa0;74% for OR) but a higher reinfection rate (42 % <i>vs</i>.&#xa0;18 %). The 5‑year survival rates are similar (EVAR: 57–79.7%, OR: 60%). The most common pathogens were <i>Salmonella</i> (26.3%) and <i>Staphylococcus aureus</i> (13.9%). Blood cultures remained negative in 37.4%. Risk factors are advanced age, male gender and comorbidities. A&#xa0;long-term antibiotic therapy of &gt; 6&#xa0;months improves the outcome.</p> Conclusion <p>The treatment of MAA requires an individualized approach as both OR and EVAR exhibit similar long-term outcomes but different early complication rates. Long-term antibiotic therapy is essential for an optimal outcome.</p>

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Das mykotische Aortenaneurysma – repräsentative Fälle

  • 期刊论文

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  • 发表日期：

    2025年9月16日

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  • E. Schwarz,
  • P. Arndt,
  • F. Meyer,
  • M. Pech,
  • U. Barth

摘要

Background

The mycotic aortic aneurysm (MAA) is a rare life-threatening condition. Treatment options include open surgical resection (OR) with prosthesis implantation and endovascular aortic repair (EVAR).

Aim

Presentation of the therapeutic decisions illustrated by clinical case examples and discussion of current references from the medical scientific literature.

Case reports

1. An emergency resection of a covered ruptured abdominal aortic aneurysm (AAA) in a 74-year-old female patient revealed a MAA. A xenograft was implanted. Ultimately, the comorbidities led to death. 2. A 79-year-old male patient with a MAA as the focus of a Salmonella sepsis underwent EVAR using implantation of a stent graft. Correct graft placement and adequate perfusion were confirmed. On postoperative day 7, the patient was discharged with long-term antibiotic therapy. 3. A 63-year-old male patient with a covered ruptured AAA and psoas muscle abscess underwent emergency surgery with OR and implantation of a xenograft prosthesis. On postoperative day 12 the patient was discharged with long-term antibiotic therapy.

Discussion

An analysis of 21 studies (2433 patients) showed a better short-term survival using EVAR (3-month survival, 96% vs. 74% for OR) but a higher reinfection rate (42 % vs. 18 %). The 5‑year survival rates are similar (EVAR: 57–79.7%, OR: 60%). The most common pathogens were Salmonella (26.3%) and Staphylococcus aureus (13.9%). Blood cultures remained negative in 37.4%. Risk factors are advanced age, male gender and comorbidities. A long-term antibiotic therapy of > 6 months improves the outcome.

Conclusion

The treatment of MAA requires an individualized approach as both OR and EVAR exhibit similar long-term outcomes but different early complication rates. Long-term antibiotic therapy is essential for an optimal outcome.