Therapeutic Opinion on Endovascular Repair for Mycotic Aortic Aneurysm Yao-Kuang Huang, 1,2,3 Po-Jen Ko, 2 Chyi-Liang Chen, 4 Feng-Chun Tsai, 2 Chi-Hsiung Wu, 1 Pyng Jing Lin, 2 and Cheng-Hsun Chiu, 3,4 Taipei, Taoyuan and Chia-Yi, Taiwan Background: Our aim in this study was to assess the feasibility of endovascular repair for mycotic aortic aneurysms (MAAs) and to provide a therapeutic opinion. Methods: We retrospectively reviewed the records of 12 patients who underwent endovascular repair for MAAs between September 2006 and June 2011. Results: Patients consisted of 9 men and 3 women, with a median age of 64.6 years (range 45e75 years). The aortic aneurysms were in the thoracic/thoracoabdominal aorta in 5 patients, juxtarenal aorta with visceral involvement in 2 patients, and infrarenal abdominal aorta in 5 patients. Blood cultures of 10 patients (83.3%) were positive for bacteria and showed Salmonella species (8 patients), Klebsiella pneumonia (1 patient), and Escherichia coli (1 patients). Eight patients with active sepsis or active bleeding underwent emergent endovascular repair because of unstable hemodynamics. Notably, 2 patients required adjuvant surgery for complete removal of infectious foci. No deaths occurred within 30 days after intervention. We recorded 2 late deaths: 1 patient died of progressive pneumonia on day 39 after intervention and the other died of liver failure on day 58 after intervention. Late complications were observed in 3 patients, 1 of whom needed an aortic revision for late prosthesis infection. The mean follow-up time was 24 ± 19.7 months. Conclusions: Endovascular repair is a feasible therapeutic option for MAAs in that it can both stop bleeding and exclude the aneurysms. Although the aortic interventions performed were successful, the patients had an immunocompromised status and a difficult postoperative recovery. ‘‘Aggressive’’ surgical drainage may be necessary in some patients and may lead to a better outcome. INTRODUCTION Mycotic (infected) aortic aneurysm (MAA) is a rare but dangerous disease, with a prevalence rate of 0.7e3% among all aortic aneurysms. 1 The natural course of this disease is characterized by a high risk of expansion and rupture. 2,3 The classic symptoms of MAAdfever, malaise, and leukocytosisdare nonspecific and often lead to late diagnosis and treatment. Advancements in imaging modalities and screening techniques, such as multidetector computed tomography, Doppler ultrasonography, and magnetic resonance imaging, have been useful in early detection of MAAs in clinically suspected cases. Traditional MAA treatment consists of open surgical repair with resection of the infected seg- ment, extensive local debridement, and in situ or extra-anatomic bypass. 4e8 Despite advances in peri- operative management and antimicrobial therapy, This study was supported by National Science Council of the Republic of China, Taiwan (Contract No. NSC 99-2314-B-182A-049-MY2), and Chang Gung Memorial Hospital, Chiayi, Taiwan (Contract No. CMRPG-6B0501). 1 Graduate Institute of Clinical Medicines, College of Medicine, Taipei Medical University, Taipei, Taiwan. 2 Division of Thoracic and Cardiovascular Surgery, Chang Gung Memorial Hospital, Chia-yi and Linkou center, Taoyuan, Taiwan. 3 College of Medicine, Chang Gung University, Taoyuan, Taiwan. 4 Division of Pediatric Infectious Diseases, Department of Pediatrics, Chang Gung Children’s Hospital, Chang Gung University College of Medicine, Taoyuan, Taiwan. Correspondence to: Cheng-Hsun Chiu, MD, Division of Pediatric Infectious Diseases, Department of Pediatrics, Chang Gung Children’s Hospital, Chang Gung University College of Medicine, 199 Tun-Hwa N Road, Taipei 105, Taiwan; E-mail: huang137@mac.com Ann Vasc Surg 2014; 28: 579–589 http://dx.doi.org/10.1016/j.avsg.2013.07.009 Ó 2014 Elsevier Inc. All rights reserved. Manuscript received: April 9, 2012; manuscript accepted: July 25, 2013; published online: January 6, 2014. 579