| Objective:Mycotic aortic aneurysm(mycotic aortic aneurysm,MAA)is a rare but deadly dilated aorta diseases.Open surgery(such as in situ reconstruction technique and anatomic reconstruction technique)has always been the "gold standard" for the treatment of MAA,but due to the difficulty of operation,long operation time and high perioperative mortality,it is hard to save critically ill patients.Endovascular techniques are increasingly used in the treatment of MAA because they make up for the shortcomings of open surgery,but are also criticized for their potential to increase the risk of graft infection.The purpose of this study was to explore the factors affecting the prognosis of MAA by analyzing the nine-year diagnosis and treatment experience of MAA,and to analyze the role and deficiencies of the application of intracavitary techniques in the diagnosis and treatment of MAA compared with open surgery.Methods:According to inclusion and exclusion criteria,28 patients with mycotic aortic aneurysm and mycotic common iliac aneurysm in the department of shandong provincial hospital from December 2010 to December 2019 were collected,including 9 patients with open surgery and 15 patients with intracavitary repair surgery.Patients'basic information,disease information,laboratory examination,aneurysm characteristics,treatment information and follow-up information were collected retrospectively.Results:A total of 28 patients with mycotic aortic aneurysm and mycotic common iliac aneurysm were included in the study,with a male to female ratio of 13:1 and an average age of 63.39±5.73)years old.Patients diagnosed with mycotic aortic aneurysm and mycotic common iliac aneurysm at admission accounted for 29.36%of the total patients,and the average length of stay was 23.78±16.61)days.The most common symptoms were abdominal pain(22/28,78.57%)and fever(19/28,67.86%).At the time of admission,32.14%was accompanied by increased WBC(>9.5*109/L).The pathogenic bacteria were salmonella,accounting for 21.42%,escherichia coli(10.71%,3/28),brucella(10.71%,3/28),staphylococcus(10.71%,3/28),etc.The aneurysm sites included the aortic arch(10.71%),the descending aorta(7.14%),the visceral region(10.71%),the inferior abdominal aorta(42.85%),and the iliac artery(14.28%).The aneurysm was lobulated in 10.71%(3/28)of the patients,and there was gas shadow in 10.71%(3/28)of the patients,and 50%(14/28)of the patients had atherosclerotic plaques.39%(11/28)of the patients had been treated with antibiotics before admission,and 37%(9/24)had no records of any antibiotic treatment before surgery.Of the patients admitted to hospital for antibiotic treatment.100%had been recorded to have used broad-spectrum antibiotics,and 43%(6/14)had been recorded to have used three or more drugs in combination or in succession;The aminoglycoside drug imipenem was used for preoperative treatment in 21%(6/24)of MAA patients and postoperative antibiotic treatment in 29%(7/24)of MAA patients.with an average duration of 12.41(SD 7.83)days.There was no significant correlation between preoperative antibiotic use for more than 3 weeks and postoperative survival(p=0.25)and postoperative graft infection(p=0.18)Postoperative graft infection in MAA patients may be related to the time of preoperative use of antibiotics(p=0.004),and the time of postoperative use of antibiotics may be correlated with the survival of MAA patients(p=0.01)and postoperative graft;infection(p=0.003).Open surgery for repair of infected aortic aneurysms(including open surgery in situ reconstruction and open surgery for external bypass reconstruction)accounted for 31.14%(9/28),and endovascular repair(including branching reconstruction and debranching)accounted for 53.57%(15/28).The 3-month/1-year/5-year survival rates were 93.33/80%and 72%,respectively.which were significantly different from the overall survival rates of open surgery(p 0.0203).The patients with signs of postoperative graft infection accounted for about 33%of the total study population,and all of them were patients receiving intracavitary treatment(100%),accounting for 61%of the total intracavitary treatment population.Higher perioperative refractory and prolonged high WBC levels(>9.5*109/L)may be associated with poor prognosisConclusion:EVAR technique has certain advantages in the rescue of patients with arterial rupture and unstable hemodynamics in patients with aortoenteric fistula or tracheal fistula.However,it still has a high risk of postoperative graft infection,especially for patients whose infection is difficult to control.EVAR may be considered as a buffer for critically ill MAA patients.In the event of poor postoperative infection control,open surgery to remove the graft and reconstruct the aorta may be considered for patients who are able to tolerate open surgery. |
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