Endovascular Treatment of Infected Aortic Aneurysms: A Retrospective Multicenter Analysis from the GORE®GREAT Registry Study

Gabriele Piffaretti; Viviana Grassi; Chiara Lomazzi; Fred Weaver; Tim Mandigers; Daniele Bissacco; Gib R Upchurch jr; Santi Trimarchi

doi:10.61797/ijetit.v5i2.347

Gabriele Piffaretti Department of Medicine and Surgery, University of Insubria School of Medicine,Varese, Italy
Viviana Grassi Fondazione IRCCS Cà Granda, Ospedale Maggiore Policlinico and Department of Clinical and Community Sciences, University of Milan, Milan, Italy
Chiara Lomazzi Fondazione IRCCS Cà Granda, Ospedale Maggiore Policlinico and Department of Clinical and Community Sciences, University of Milan, Milan, Italy
Fred Weaver USC Comprehensive Aortic Center, CardioVascular Thoracic Institute, Keck Medical Center of USC Los Angeles, CA, USA
Tim Mandigers Fondazione IRCCS Cà Granda, Ospedale Maggiore Policlinico and Department of Clinical and Community Sciences, University of Milan, Milan, Italy
Daniele Bissacco Fondazione IRCCS Cà Granda, Ospedale Maggiore Policlinico and Department of Clinical and Community Sciences, University of Milan, Milan, Italy
Gib R Upchurch Department of Surgery, University of Florida College of Medicine Gainesville, FL, USA
Santi Trimarchi Fondazione IRCCS Cà Granda, Ospedale Maggiore Policlinico and Department of Clinical and Community Sciences, University of Milan, Milan, Italy

DOI: https://doi.org/10.61797/ijetit.v5i2.347

Keywords: Infected aneurysm, Mycotic aneurysm, Endovascular aortic repair, Endograft infection, Saccular aneurysm

Abstract

Objective: The Global Registry for Endovascular Aortic Treatment (GREAT), which is a retrospective sponsored registry (W.L Gore & Associates; Flagstaff – AZ; USA), was queried to evaluate the outcomes of infected aortic aneurysms (inf-AAs) after abdominal (EVAR) or thoracic endovascular aortic repair (TEVAR).

Methods: This is a multicenter, observational cohort study. For the current study, all patients were treated only with the standard GORE^® devices for INFAA. Primary graft infections, aorto-enteric fistulae, and graft-enteric fistulae were excluded, as well as cases that did not meet the predefined criteria of an inf-AA. All serious adverse events within 30 days of the procedure were documented by sites. Primary outcomes were early (≤ 30 days) and late survival, and freedom from endograft infection.

Results: Thirty-one (0.6% of the entire GREAT cohort) patients met the inclusion criteria and were included: 23 (74.2%) were males and 8 (25.8%) females. The mean age was 72 years ± 11 (range, 49-92). This included 26 (83.9%) abdominal inf-AAs and 5 (16.1%) thoracic inf-AAs. Operative-related mortality occurred in 1 (3.2%) patient. Immediate conversion to open surgical repair was not required. Mean follow-up was 23.6 ± 15 months (range, 1-49): estimated survival rate was 80% (95%CI, 60.8-90.5) at 12 months, and 53.2% (95%CI, 30.0-71.1) at 48 months. Secondary aortic rupture as well as endograft explanation was also not reported.

Conclusion: Endovascular treatment of inf-AA is feasible and effective. While endograft infection was not detected during the follow-up, long-term results from GREAT registry may reveal how durable T/EVAR could be for inf-AAs.