Huang YK, et al. Clinical, microbiologic, and outcome analysis of mycotic aortic aneurysm: the role of endovascular repair. Surg Infect (Larchmt). 2014 Jun;15(3): 290-8.
Click to enlarge.
Results: All of the patients had positive blood cultures, radiologic findings typical of MAA, and clinical signs of infection (leukocytosis, fever, and elevated C-reactive protein). The mean age of the patients was 63.8±10.6 y and the mean period of their follow up was 35.7±39.3 mo. Twenty-nine patients with MAAs underwent traditional open surgery, 11 others received endovascular stent grafts, and four MAAs were managed conservatively. The most frequent causative pathogens were Salmonella (36/44 patients [81.8%]), in whom organisms of Salmonella serogroup C (consisting mainly of S. choleraesuis) were identified in 14 patients, organisms of Salmonella serogroup D were identified in 13 patients, and species without serogroup information were identified in nine patients. The overall mortality in the study population was 43.2% (with an aneurysm-related mortality of 18.2%, surgically related mortality of 13.6%, and in-hospital mortality of 22.7%).
Presented by Amanda Fobare, MD, Chief Resident
Department of Surgery, Emory University School of Medicine
February 27, 2020
The evidence: EVAR vs. open repair for elective AAA repair:
- EVAR 1 – Endovascular Aneurysm Repair Trial 1 (UK)- Lancet (2005, 2016)
- DREAM – Dutch Randomized Endovascular Aneurysm Management Trial (Netherlands & Belgium)- NEJM (2004), JVS (2017)
- OVER – Open versus Endovascular Repair Trial (USA)- JAMA (2009), NEJM (2012)
One discussion this week included transperitoneal vs retroperitoneal approach following AAA repair.
Reference: Buck DB, et al. Transperitoneal vs retroperitoneal approach for open abdominal aortic aneurysm repair in the targeted vascular NSQIP. Journal of Vascular Surgery. 2016 Sept;64(3):585-591. doi:10/1016/j.jvs.2016.01.055.
Summary: This study aims to identify the demographic and anatomical differences between patients currently selected for elective transperitoneal versus retroperitoneal AAA repair and to assess differences in intra-operative details, and perioperative mortality and complications.