ReviewChirurgie (Heidelberg, Germany)2026
[Mycotic aortic aneurysm-Representative cases : Case series of clinical case examples and the current literature on the treatment options of open surgical resection with prosthesis implantation (OR) and endovascular aortic repair (EVAR)].
Review in Chirurgie (Heidelberg, Germany), 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundThe mycotic aortic aneurysm (MAA) is a rare life-threatening condition. Treatment options include open surgical resection (OR) with prosthesis implantation and endovascular aortic repair (EVAR).
aimPresentation of the therapeutic decisions illustrated by clinical case examples and discussion of current references from the medical scientific literature. CASE REPORTS: 1. An emergency resection of a covered ruptured abdominal aortic aneurysm (AAA) in a 74-year-old female patient revealed a MAA. A xenograft was implanted. Ultimately, the comorbidities led to death. 2. A 79-year-old male patient with a MAA as the focus of a Salmonella sepsis underwent EVAR using implantation of a stent graft. Correct graft placement and adequate perfusion were confirmed. On postoperative day 7, the patient was discharged with long-term antibiotic therapy. 3. A 63-year-old male patient with a covered ruptured AAA and psoas muscle abscess underwent emergency surgery with OR and implantation of a xenograft prosthesis. On postoperative day 12 the patient was discharged with long-term antibiotic therapy. DISCUSSION: An analysis of 21 studies (2433 patients) showed a better short-term survival using EVAR (3-month survival, 96% vs. 74% for OR) but a higher reinfection rate (42 % vs. 18 %). The 5‑year survival rates are similar (EVAR: 57-79.7%, OR: 60%). The most common pathogens were Salmonella (26.3%) and Staphylococcus aureus (13.9%). Blood cultures remained negative in 37.4%. Risk factors are advanced age, male gender and comorbidities. A long-term antibiotic therapy of > 6 months improves the outcome.
conclusionThe treatment of MAA requires an individualized approach as both OR and EVAR exhibit similar long-term outcomes but different early complication rates. Long-term antibiotic therapy is essential for an optimal outcome.
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