Overview
Infective aneurysms, including those involving the aortic structures, are uncommon but serious complications often associated with endocarditis, characterized by localized infection leading to aneurysmal dilation and potential rupture. 12Diagnosis
Clinical Presentation: Often associated with systemic signs of infection (fever, leukocytosis) and local symptoms related to aneurysm location.
Imaging: CT angiography and MRI are crucial for identifying aneurysm location, size, and involvement of surrounding structures. 13
Pathogen Identification: Blood cultures and imaging studies (e.g., CT, MRI) help in diagnosing the causative organism. 136
Grading: No specific grading system universally accepted; clinical severity often guides management decisions. 2Management
Antimicrobial Therapy: Tailored to the identified pathogen, often requiring prolonged courses (e.g., weeks to months). Specific pathogens like Salmonella spp. necessitate appropriate antibiotic coverage. 136
Surgical Intervention: Endovascular repair (EVAR) is increasingly favored over open surgery for thoracic and abdominal aneurysms, showing lower in-hospital mortality but higher long-term mortality risk in some cases. 34
Surgical Outcomes: Open surgery may still be indicated in complex cases, particularly with rupture or extensive involvement. 1
Follow-Up: Regular imaging and clinical monitoring essential to assess treatment efficacy and detect recurrence or complications. 2Special Populations
Elderly: Higher risk of complications; careful consideration of surgical versus endovascular approaches based on comorbidities and aneurysm specifics. 1
Comorbidities: Presence of comorbidities like chronic kidney disease influences both treatment choice and prognosis, often necessitating multidisciplinary management. 3Key Recommendations
Initiate targeted antimicrobial therapy based on blood cultures and imaging findings to address the causative pathogen, especially in cases involving Salmonella spp. (Evidence: Moderate 36)
Consider endovascular repair (EVAR) for infective aortic aneurysms due to lower in-hospital mortality compared to open surgery, though monitor for higher long-term mortality risks. (Evidence: Moderate 34)
Implement rigorous follow-up protocols including serial imaging and clinical assessments to manage and detect complications effectively. (Evidence: Expert opinion 2)References
1 Gonzalez-Urquijo M, Mertens R, Vargas JF, Marine L, Bergoeing M, Valdes F et al.. Surgical Outcomes of Infective Native Aortoiliac Aneurysms in a Chilean Academic Center. Annals of vascular surgery 2024. link
2 Wyss TR, Giardini M, Sörelius K. Infective Native Aortic Aneurysm: a Delphi Consensus Document on Treatment, Follow Up, and Definition of Cure. European journal of vascular and endovascular surgery : the official journal of the European Society for Vascular Surgery 2024. link
3 Lee CC, Chen DY, Chan YH, Wu VC, Cheng YT, Hung KC et al.. Outcomes of Endovascular Treatment for Infective Aortic Aneurysms - A Multicenter Retrospective Study. Circulation journal : official journal of the Japanese Circulation Society 2024. link
4 Jutidamrongphan W, Kritpracha B, Sörelius K, Chichareon P, Chongsuvivatwong V, Sungsiri J et al.. Predicting Infection Related Complications After Endovascular Repair of Infective Native Aortic Aneurysms. European journal of vascular and endovascular surgery : the official journal of the European Society for Vascular Surgery 2023. link
5 Venkatesh SK, Phadke RV, Kalode RR, Kumar S, Jain VK. Intracranial infective aneurysms presenting with haemorrhage: an analysis of angiographic findings, management and outcome. Clinical radiology 2000. link
6 Habozit B, Cressens JP, Battistelli JM. Infective aneurysm of the popliteal artery due to Salmonella enteritidis. Annals of vascular surgery 1992. link