Abstract
Objective This retrospective case series reports the 15-year experience of the endovascular
management of mycotic aortic and iliac aneurysms (MAAs) at a tertiary referral center
in the United Kingdom.
Materials and Methods The patients were identified through advanced searches in picture archiving and communication
system (PACS) and electronic patient records. Data were retrieved and recorded in
a structured spreadsheet including demographic details, symptoms and comorbidities,
endovascular techniques employed and graft types, as well as treatment outcomes including
30-day mortality, 1-, 3-, and 5-year survival, aneurysm resolution percentage, and
rates of re-intervention and complications.
Statistical Analysis Descriptive statistics summarized the demographic and clinical characteristics, presenting
them as means for continuous variables and frequencies/percentages for categorical
variables.
Results Of the 15 included patients, 73.3% (11/15) and 26.7% (4/15) were males and females,
respectively, with a mean age of 64 years. Imaging revealed diverse anatomical involvement,
with MAA in the descending thoracic (6/15), suprarenal and juxtarenal (5/15), infrarenal
(3/15), and common iliac arteries (1/15). The 30-day mortality rate was 6.7% (1/15),
while 1-, 3-, and 5-year survival rates from time of initial intervention were 57.1%
(8/14), 38.5% (5/13), and 30.8% (4/13), respectively, with 1 case only just having
undergone 1-month follow-up (performed in July 2023). The average mycotic aneurysm
size was 47 mm (range: 19–80 mm), of which 33.3% (5/15) presented with rupture. The
average sac size reduction following treatment was 31%, with 5/15 cases demonstrating
complete resolution. Four cases required re-intervention due to persistent endoleak,
sac re-expansion secondary to delayed endoleak, or stent occlusion. Persistent or
recurrent graft infection was observed in 53.3% (8/15) of cases. Two cases required
surgical re-intervention for stent occlusion.
Conclusion Our findings reinforce the role of endovascular interventions in MAA acute management,
showcasing immediate survival benefits. Late complications and frequent re-interventions
emphasize the importance of vigilant surveillance.
Keywords
endovascular - aortic aneurysm - mycotic - aortic graft
