Khamin Chinsakchai
Current Position
Associate Professor
Faculty of Medicine Siriraj Hospital, Mahidol university
Abdominal Aorta & Aortic iliac Session

Topic: Early and Late Outcomes of Endovascular Aneurysm Repair for Infected Abdominal Aortic Aneurysms


Background: Infected abdominal aortic aneurysm (AAA) is a rare condition. This condition has increasingly been treated with endovascular aneurysm repair (EVAR). However, early, and late outcomes, including the continued need for antibiotic treatments and predictors of persistent infection, are poorly understood.
Methods: We evaluated the outcomes of patients who underwent EVAR for infected AAA from January 2010 to October 2017. We collected data including clinical presentation, aneurysm location, culture results, intraoperative details, postoperative complications, 30-day mortality, in-hospital mortality, persistent infection, reintervention, and survival.
Results: Among 792 patients diagnosed with AAA, 64 were diagnosed with primary infected aneurysm, underwent EVAR, and were included in this study (81.3% male; median age, 72 years; range, 18–94 years). The most isolated organisms were Salmonella species (34%). Aneurysms were intact in 48 patients (75%) and were ruptured in 16 (25%). The perioperative mortality was 4.7% (3 patients). Six (9.4%) patients died during hospitalization. Among the 58 surviving patients, 34 (58.6%) had persistent infection, of whom 13(22.4%) required early and late reintervention. The remaining 24 patients were able to discontinue antibiotics and had no recurrence or need for reintervention. Overall survival rates at 1, 3, and 5 years in the antibiotic-discontinuation group were 91.7%, 87.5%, and 68.0%, respectively, and 82.4%, 52.6%, and 32.9%, respectively, in the persistent-infection group (P = 0.009). In multivariable analysis, primary aortoenteric fistula and preoperative serum albumin level < 3 g/dL were preoperative parameter that predicted persistent infection. A C-reactive protein level more than 5 mg/L was observed in patients with persistent infection.
Conclusion: EVAR is a feasible treatment with acceptable perioperative mortality for infected AAA. Patients able to discontinue antibiotics have better survival and lower reintervention rates than those with persistent infection. A preoperative albumin level below 3 g/dL and primary aortoenteric fistula predicted persistent infection in this population.