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  • 1. Acosta, Stefan
    et al.
    Seternes, Arne
    Venermo, Maarit
    Vikatmaa, Leena
    Sörelius, Karl
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Vascular Surgery.
    Wanhainen, Anders
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Vascular Surgery.
    Svensson, Mats
    Djavani, Khatereh
    Department of Surgery, Gävle Hospital, Gävle, Sweden.
    Björck, Martin
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Vascular Surgery.
    Open Abdomen Therapy with Vacuum and Mesh Mediated Fascial Traction After Aortic Repair: an International Multicentre Study2017In: European Journal of Vascular and Endovascular Surgery, ISSN 1078-5884, E-ISSN 1532-2165, Vol. 54, no 6, p. 697-705Article in journal (Refereed)
    Abstract [en]

    OBJECTIVES:

    Open abdomen therapy may be necessary to prevent or treat abdominal compartment syndrome (ACS). The aim of the study was to analyse the primary delayed fascial closure (PDFC) rate and complications after open abdomen therapy with vacuum and mesh mediated fascial traction (VACM) after aortic repair and to compare outcomes between those treated with open abdomen after primary versus secondary operation.

    METHODS:

    This was a retrospective cohort, multicentre study in Sweden, Finland, and Norway, including consecutive patients treated with open abdomen and VACM after aortic repair at six vascular centres in 2006-2015. The primary endpoint was PDFC rate.

    RESULTS:

    Among 191 patients, 155 were men. The median age was 71 years (IQR 66-76). Ruptured abdominal aortic aneurysm (RAAA) occurred in 69.1%. Endovascular/hybrid and open repairs were performed in 49 and 142 patients, respectively. The indications for open abdomen were inability to close the abdomen (62%) at primary operation and ACS (80%) at secondary operation. Duration of open abdomen was 11 days (IQR 7-16) in 157 patients alive at open abdomen termination. The PDFC rate was 91.8%. Open abdomen initiated at primary (N=103), compared with secondary operation (N=88), was associated with less severe initial open abdomen status (p=.006), less intestinal ischaemia (p=.002), shorter duration of open abdomen (p=.007), and less renal replacement therapy (RRT, p<.001). In hospital mortality was 39.3%, and after entero-atmospheric fistula (N=9) was 88.9%. Seven developed graft infection within 6 months, 1 year mortality was 28.6%. Intestinal ischaemia (OR 3.71, 95% CI 1.55-8.91), RRT (OR 3.62, 95% CI 1.72-7.65), and age (OR 1.12, 95% CI 1.06-1.12), were independent factors associated with in hospital mortality, but not open abdomen initiated at primary versus secondary operation.

    CONCLUSIONS:

    VACM was associated with a high PDFC rate after prolonged open abdomen therapy following aortic repair. Patient outcomes seemed better when open abdomen was initiated at primary, compared with secondary operation but a selection effect is possible.

  • 2.
    Brown, Peter
    et al.
    Griffith Univ, Sch Informat & Commun Technol, Gold Coast, Australia.
    Sörelius, Karl
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Vascular Surgery.
    Zhou, Yaoqi
    Griffith Univ, Sch Informat & Commun Technol, Gold Coast, Australia.
    Large expert-curated database for benchmarking document similarity detection in biomedical literature search2019In: Database: The Journal of Biological Databases and Curation, ISSN 1758-0463, E-ISSN 1758-0463, article id baz085Article in journal (Refereed)
    Abstract [en]

    Document recommendation systems for locating relevant literature have mostly relied on methods developed a decade ago. This is largely due to the lack of a large offline gold-standard benchmark of relevant documents that cover a variety of research fields such that newly developed literature search techniques can be compared, improved and translated into practice. To overcome this bottleneck, we have established the RElevant LIterature SearcH consortium consisting of more than 1500 scientists from 84 countries, who have collectively annotated the relevance of over 180 000 PubMed-listed articles with regard to their respective seed (input) article/s. The majority of annotations were contributed by highly experienced, original authors of the seed articles. The collected data cover 76% of all unique PubMed Medical Subject Headings descriptors. No systematic biases were observed across different experience levels, research fields or time spent on annotations. More importantly, annotations of the same document pairs contributed by different scientists were highly concordant. We further show that the three representative baseline methods used to generate recommended articles for evaluation (Okapi Best Matching 25, Term Frequency-Inverse Document Frequency and PubMed Related Articles) had similar overall performances. Additionally, we found that these methods each tend to produce distinct collections of recommended articles, suggesting that a hybrid method may be required to completely capture all relevant articles. The established database server located at https://relishdb.ict.griffith.edu.au is freely available for the downloading of annotation data and the blind testing of new methods. We expect that this benchmark will be useful for stimulating the development of new powerful techniques for title and title/abstract-based search engines for relevant articles in biomedical research.

  • 3.
    Heinola, Ivika
    et al.
    Univ Helsinki, Dept Vasc Surg, Helsinki, Finland;Helsinki Univ Hosp, Helsinki, Finland.
    Sörelius, Karl
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Vascular Surgery.
    Wyss, Thomas R.
    Univ Bern, Bern Univ Hosp, Inselspital, Dept Cardiovasc Surg, Bern, Switzerland.
    Eldrup, Nikolaj
    Aarhus Univ Hosp, Dept Cardiothorac & Vasc Surg, Aarhus, Denmark.
    Settembre, Nicla
    Nancy Univ Hosp, Dept Vasc Surg, Nancy, France.
    Setacci, Carlo
    Univ Siena, Dept Med Surg & Neurosci, Siena, Italy.
    Mani, Kevin
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Vascular Surgery.
    Kantonen, Ilkka
    Univ Helsinki, Dept Vasc Surg, Helsinki, Finland;Helsinki Univ Hosp, Helsinki, Finland.
    Venermo, Maarit
    Univ Helsinki, Dept Vasc Surg, Helsinki, Finland;Helsinki Univ Hosp, Helsinki, Finland.
    Open Repair of Mycotic Abdominal Aortic Aneurysms With Biological Grafts: An International Multicenter Study2018In: Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease, ISSN 2047-9980, E-ISSN 2047-9980, Vol. 7, no 12, article id e008104Article in journal (Refereed)
    Abstract [en]

    Background-The treatment of mycotic abdominal aortic aneurysm requires surgery and antimicrobial therapy. Since prosthetic reconstructions carry a considerable risk of reinfection, biological grafts are noteworthy alternatives. The current study evaluated the durability, infection resistance, and midterm outcome of biological grafts in treatment of mycotic abdominal aortic aneurysm. Methods and Results-All patients treated with biological graft in 6 countries between 2006 and 2016 were included. Primary outcome measures were 30- and 90-day survival, treatment-related mortality, and reinfection rate. Secondary outcome measures were overall mortality and graft patency. Fifty-six patients (46 males) with median age of 69 years (range 35-85) were included. Sixteen patients were immunocompromised (29%), 24 (43%) had concomitant infection, and 12 (21%) presented with rupture. Bacterial culture was isolated from 43 (77%). In-situ aortic reconstruction was performed using autologous femoral veins in 30 patients (54%), xenopericardial tube-grafts in 12 (21%), cryopreserved arterial/venous allografts in 9 (16%), and fresh arterial allografts in 5 (9%) patients. During a median follow-up of 26 months (range 3 weeks-172 months) there were no reinfections and only 3 patients (5%) required assistance with graft patency. Thirty-day survival was 95% (n=53) and 90-day survival was 91% (n=51). Treatment-related mortality was 9% (n=5). Kaplan-Meier estimation of survival at 1 year was 83% (95% confidence interval, 73%-94%) and at 5 years was 71% (52%-89%). Conclusions-Mycotic abdominal aortic aneurysm repair with biological grafts is a durable option for patients fit for surgery presenting an excellent infection resistance and good overall survival.

  • 4.
    Sörelius, Karl
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Vascular Surgery.
    Aortic infections: The Nadir of Vascular Surgery2016Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    Aortic infections are rare, life-threatening and constitute a major challenge in surgical management. This thesis aims to evaluate short – and long-term outcome of endovascular aortic repair (EVAR) for mycotic aortic aneurysms (MAA) and the subsequent risk of recurrent infections, changes in surgical practice over time for abdominal MAAs in Sweden and outcome for different treatment modalities, as well as the risk of secondary vascular infection after treatment with Open abdomen after aortic surgery.

    Paper I, a retrospective single centre study of patients with MAA treated with EVAR, demonstrated a good short-term outcome, 91% survival at 30-days, and acceptable mid-term survival, 73% at 1-year.

    Paper II, a retrospective international multicentre study of patients treated with EVAR for MAA, confirmed the results in paper I, and showed that EVAR is feasible and for most MAA patients a durable treatment option, 5-year survival was 55% and 10-year 41%. A total of 19% died from an infection-related complication, mostly during the first postoperative year. Non-Salmonella-positive culture was a predictor for late infection–related death.

    Paper III, a population-based cohort study on all abdominal MAAs operated on between 1994-2014 in Sweden. Overall survival was 86% at 3-months, 79% at 1-year and 59% at 5-years. The survival was significantly better after endovascular compared to open repair up to 1-year without increasing recurrence of infection or reoperation, thereafter there was no difference. After 2001 EVAR constituted 60 % of all repairs, thus indicating a paradigm shift in treatment for abdominal MAAs in Sweden.

    Paper IV, a prospective multicentre study of patients treated with open abdomen after aortic surgery. Infectious complications, such as graft infections, occurred after intestinal ischaemia and prolonged OA-treatment, and were often fatal.

    List of papers
    1. Endovascular repair of mycotic aortic aneurysms
    Open this publication in new window or tab >>Endovascular repair of mycotic aortic aneurysms
    Show others...
    2009 (English)In: Journal of vascular surgery, ISSN 0741-5214, Vol. 50, no 2, p. 269-274Article in journal (Refereed) Published
    Abstract [en]

    PURPOSE: We report our single-center experience of early and midterm outcome after endovascular repair of mycotic aortic aneurysms (MAA). METHODS: Case records were retrospectively reviewed of 11 patients who underwent endovascular repair of 13 MAAs between 2000 and 2007. The aneurysms were localized in the aortic arch in 1 patient, descending thoracic aorta in 4, suprarenal abdominal aorta in 3, and infrarenal abdominal aorta in 5. RESULTS: Mean follow-up was 27 months. A bleeding aortoesophageal fistula resulted in one in-hospital death <or=30 days. Three patients died later: one each of sepsis, stent migration that caused intestinal ischemia, and an unknown cause. Two patients had recurrent sepsis postoperatively but no vascular complications, two had elevated inflammatory markers during follow-up but were asymptomatic, and three patients had an uneventful follow-up. CONCLUSIONS: Endovascular treatment for MAA was feasible, with acceptable perioperative mortality and midterm outcome in this single-center case series. Recurrent sepsis and late relapse with a second MAA occurred, indicating the need of long-term antibiotic therapy and follow-up, as well as the possible need for secondary open repair in selected cases. Further research is warranted to evaluate long-term outcome.

    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:uu:diva-110122 (URN)10.1016/j.jvs.2009.01.001 (DOI)000268610000005 ()19446985 (PubMedID)
    Available from: 2009-11-04 Created: 2009-11-04 Last updated: 2016-08-31Bibliographically approved
    2. Endovascular Treatment of Mycotic Aortic Aneurysms A European Multicenter Study
    Open this publication in new window or tab >>Endovascular Treatment of Mycotic Aortic Aneurysms A European Multicenter Study
    Show others...
    2014 (English)In: Circulation, ISSN 0009-7322, E-ISSN 1524-4539, Vol. 130, no 24, p. 2136-2142Article in journal (Refereed) Published
    Abstract [en]

    Background-Mycotic aortic aneurysm (MAA) is a rare and life-threatening disease. The aim of this European multicenter collaboration was to study the durability of endovascular aortic repair (EVAR) of MAA, by assessing late infection-related complications and long-term survival. Methods and Results-All EVAR treated MAAs, between 1999 and 2013 at 16 European centers, were retrospectively reviewed. One hundred twenty-three patients with 130 MAAs were identified. Mean age was 69 years (range 39-86), 87 (71%) were men, 58 (47%) had immunodeficiency, and 47 (38%) presented with rupture. Anatomic locations were ascending/arch (n=4), descending (n=34), paravisceral (n=15), infrarenal aorta (n=63), and multiple (n=7). Treatments were thoracic EVAR (n=43), fenestrated/branched EVAR (n=9), and infrarenal EVAR (n=71). Antibiotic was administered for mean 30 weeks. Mean follow-up was 35 months (range 1 week to 149 months). Six patients (5%) were converted to open repair during follow-up. Survival was 91% (95% confidence interval, 86% to 96%), 75% (67% to 83%), 55% (44% to 66%), and 41% (28% to 54%) after 1, 12, 60, and 120 months, respectively. Infection-related death occurred in 23 patients (19%), 9 after discontinuation of antibiotic treatment. A Cox regression analysis demonstrated non-Salmonella-positive culture as predictors for late infection-related death. Conclusions-Endovascular treatment of MAA is feasible and for most patients a durable treatment option. Late infections do occur, are often lethal, and warrant long-term antibiotic treatment and follow-up. Patients with non-Salmonellapositive blood cultures were more likely to die from late infection.

    Keywords
    aneurysm, aorta, infection, surgery
    National Category
    Cardiac and Cardiovascular Systems
    Identifiers
    urn:nbn:se:uu:diva-241408 (URN)10.1161/CIRCULATIONAHA.114.009481 (DOI)000346141900011 ()25378548 (PubMedID)
    Available from: 2015-01-19 Created: 2015-01-12 Last updated: 2017-12-05Bibliographically approved
    3. Nationwide study demonstrates paradigm shift in treatment of mycotic abdominal aortic aneurysms
    Open this publication in new window or tab >>Nationwide study demonstrates paradigm shift in treatment of mycotic abdominal aortic aneurysms
    Show others...
    (English)Manuscript (preprint) (Other academic)
    Abstract [en]

    Background: Radical open surgery (OR) is considered gold standard for management of mycotic abdominal aortic aneurysms (MAAAs). Endovascular repair (EVAR) is a less invasive but controversial treatment option for MAAA because the stentgraft is implanted in an infected field, whilst recent reports indicate promising outcome. No reliable comparative data exists. This nationwide study assesses outcome after OR and EVAR for MAAA in a population-based cohort.

    Methods: All patients treated in Sweden for MAAAs 1994-2014 were identified in the Swedish vascular registry. Twenty-seven vascular units participated in data collection according to a predefined protocol. Survival was cross-matched with the population registry.

    Results: 132 patients with 144 MAAAs were identified, (0.6% of all operated AAA in Sweden). Median age was 70 years (SD 9.2), 51 were immunosuppressed, and 50 presented with rupture. Survival at 3-months was 86% (95% CI 80-92%), 1-year 79% (72-86%), and 5- years 59% (50-68%).

    The preferred operative technique shifted from OR to EVAR after 2001 (proportion EVAR 1994-2000 0%, 2001-2007 58%, 2008-2014 60%). Open repair was performed in 62 patients (47%); aortic resection and extra-anatomical bypass (n=7), in-situ reconstruction (n=50), patch plasty (n=3), and two died intraoperatively OR attempt. EVAR was performed in 70 patients (53%); standard EVAR (n=55), fenestrated/branched EVAR (n=8), and visceral deviation with stentgrafting (n=7).

    Survival at 3-months was inferior for OR compared to EVAR in Kaplan-Meier analysis (74% vs 96%, p<0.001), with a similar trend present at 1-year (73% vs 84%, p=0.054). A propensity score weighted risk-adjusted analysis confirmed the early survival benefit of EVAR. During follow-up (median OR 36, EVAR 41 months) there was no difference in long- term survival (5-years 60 vs 58%, p=0.771), infection-related complications (18 vs 24%, p=0.439), or reoperation (21% vs 24%, p=0.650). In a multivariable analysis OR was a significant risk factor for death at 3-months (odds ratio 6.96, p=0.004).

    Conclusion: This study demonstrates a paradigm shift in treatment of MAAA in Sweden, with EVAR being the preferred treatment modality. EVAR achieved improved short-term survival compared to OR, without increasing the risk of serious infection-related complications or reoperations.

    Keywords
    Mycotic, infected, aortic, aneurysm, abdominal
    National Category
    Medical and Health Sciences
    Research subject
    Surgery
    Identifiers
    urn:nbn:se:uu:diva-300952 (URN)
    Available from: 2016-08-16 Created: 2016-08-16 Last updated: 2016-08-31Bibliographically approved
    4. Open Abdomen Treatment after Aortic Aneurysm Repair with Vacuum-assisted Wound Closure and Mesh-mediated Fascial Traction
    Open this publication in new window or tab >>Open Abdomen Treatment after Aortic Aneurysm Repair with Vacuum-assisted Wound Closure and Mesh-mediated Fascial Traction
    Show others...
    2013 (English)In: European Journal of Vascular and Endovascular Surgery, ISSN 1078-5884, E-ISSN 1532-2165, Vol. 45, no 6, p. 588-594Article in journal (Refereed) Published
    Abstract [en]

    OBJECTIVES:

    Open abdomen (OA) treatment is sometimes necessary after surgery for aortic aneurysm (AA), to prevent or treat abdominal compartment syndrome (ACS). A multicentre study evaluating vacuum-assisted wound closure (100-150 mmHg) and mesh-mediated fascial traction (VAWCM) was performed.

    METHODS:

    All patients treated with OA after AA repair (2006-2009) were prospectively registered at four centres; those treated <5 days were excluded. All surviving patients underwent a 1-year follow-up, including computed tomography (CT) examination.

    RESULTS:

    Among 1041 patients treated with open or endovascular repair of AA, 28 (2.9%) had OA treatment with VAWCM; another two had VAWCM after hybrid operations for thoraco-abdominal AA. Eighteen (60%) were operated on for rupture and 12 (40%) electively. Eight had suprarenal or thoraco-abdominal aneurysms. Eight (27%) died within 30 days, none due to OA-related complications. Four died before abdominal closure; primary delayed fascial closure was achieved in all survivors. One-year mortality was 50%. Ten (33%) had bowel ischaemia requiring bowel resection. Late potential OA-related infectious complications occurred in five (17%), all of whom first developed intestinal ischaemia: entero-atmospheric fistulae (two), graft infections (two), aorto-enteric fistula (one). One year follow-up with clinical evaluation and CT showed no signs of graft infection. Incisional hernias occurred in 9 of 15 patients (60%); only three were symptomatic.

    CONCLUSION:

    VAWCM provided high fascial closure rate after AA repair and long-term OA treatment. Infectious complications occur after intestinal ischaemia and prolonged OA treatment, and are often fatal. The poor prognosis among patients needing OA after AA surgery may be improved by using VAWCM, permitting earlier closure.

    Keywords
    Aortic aneurysm; Open abdomen; Vacuum-assisted wound closure; Mesh; Abdominal compartment syndrome; Mortality; Infections
    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:uu:diva-199892 (URN)10.1016/j.ejvs.2013.01.041 (DOI)000320745100010 ()23465456 (PubMedID)
    Funder
    Swedish Research Council, K2010-65X-20406-04-3
    Available from: 2013-05-17 Created: 2013-05-17 Last updated: 2017-12-06Bibliographically approved
  • 5.
    Sörelius, Karl
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Vascular Surgery.
    Re: "Management of Atherosclerotic Carotid and Vertebral Disease: 2017 Clinical Practice Guidelines of the European Society for Vascular Surgery (ESVS)"2018In: European Journal of Vascular and Endovascular Surgery, ISSN 1078-5884, E-ISSN 1532-2165, Vol. 55, no 1, p. 142-142Article in journal (Refereed)
  • 6.
    Sörelius, Karl
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Vascular Surgery.
    Budtz-Lilly, Jacob
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Vascular Surgery.
    Mani, Kevin
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Vascular Surgery.
    Wanhainen, Anders
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Vascular Surgery.
    Systematic Review of the Management of Mycotic Aortic Aneurysms2019In: European Journal of Vascular and Endovascular Surgery, ISSN 1078-5884, E-ISSN 1532-2165, Vol. 58, no 3, p. 426-435Article, review/survey (Refereed)
    Abstract [en]

    Objectives: The aim of this systematic literature review was to compile an updated overview of mycotic aortic aneurysm (MAA) treatment and outcomes.

    Methods: A systematic literature review was performed using the search terms mycotic and infected aortic aneurysms in the MEDLINE and ScienceDirect databases, published between January 2000 and September 2018. Using the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) statement, articles were scrutinised regarding surgical technique, aortic segment involved, pre- and post-operative antibiotic regimens, survival and infection related complications (IRCs), and factors associated with adverse or favourable outcomes.

    Results: Twenty-eight studies, with a total of 963 patients, were included. All publications were observational, retrospective studies. Patient and study heterogeneity, along with missing data, precluded meta-analyses. Overall treatment consisted of open surgical repair (OSR; n = 556 [58%]), endovascular aortic repair (EVAR; n = 373 [39%]), and medical treatment alone (n = 34 [3%]). OSR was the dominant surgical technique prior to 2010, shifting to EVAR thereafter. For MAAs located in the abdominal aorta, EVAR was associated with better short term survival than OSR. Antibiotic treatment for more than six months post-operatively was associated with better survival, but there was no consensus on the length of treatment. MAAs were complicated by IRCs in 21%, irrespective of surgical technique, of which 46%-70% were fatal. The most consistently reported factors associated with adverse outcomes were increasing age, rupture, suprarenal abdominal aneurysm location, and non-Salmonella positive culture.

    Conclusions: With few exceptions, the literature mainly consists of small, retrospective single centre studies. Standardised reporting is needed to increase comparability of studies. EVAR appears to be associated with superior short term survival without late disadvantages, compared with OSR. This suggests that EVAR can be an acceptable alternative to OSR. However, MAA treatment should always be tailor made and planned individually, and general recommendations are in vain. IRCs pose a significant threat to patients after MAA repair and require further investigation.

  • 7.
    Sörelius, Karl
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Vascular Surgery.
    di Summa, Pietro G.
    CHU Vaudois, Dept Plast Reconstruct & Hand Surg, Lausanne, Switzerland..
    On the Diagnosis of Mycotic Aortic Aneurysms2018In: Clinical Medicine Insights: Cardiology, ISSN 1179-5468, E-ISSN 1179-5468, Vol. 12Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: There is striking paucity in consensus on the terminology, definition, and diagnostic criteria of mycotic aortic aneurysms. This literature study aims to elucidate this scientific omission, discuss its consequences, and present a proposition for reporting items on this disease.

    METHODS: A systematic literature review on PubMed and Medline using mycotic and infected aortic aneurysms between 1850 and 2017 was performed. Articles were assessed according to a protocol regarding terminology, definition, and diagnostic criteria. Case series with less than 5 patients were excluded.

    RESULTS: A total of 49 articles were included. The most prevalent term was mycotic aortic aneurysm but there was no widely accepted definition. Most modern publications used a diagnostic workup based on a combination on clinical presentation, laboratory results, imaging findings, and intraoperative findings. How these protean variables should be balanced was unclear. A proposition of reporting items was framed and consisted of definition of disease used, basis of diagnostic workup, exclusion criteria, patient characteristics, laboratory and imaging findings, aneurysm anatomy, details on treatment, pre/postoperative antibiotic treatment, and details on follow-up.

    CONCLUSIONS: This article emphasizes the need to standardize definition, terminology, and diagnostic criteria for mycotic aortic aneurysms and proposes reporting items enhancing comparability between studies.

  • 8.
    Sörelius, Karl
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Vascular Surgery.
    Mani, Kevin
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Vascular Surgery.
    Björck, Martin
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Vascular Surgery.
    Nyman, Rickard
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Oncology, Radiology and Clinical Immunology, Radiology.
    Wanhainen, Anders
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Vascular Surgery.
    Endovascular repair of mycotic aortic aneurysms2009In: Journal of vascular surgery, ISSN 0741-5214, Vol. 50, no 2, p. 269-274Article in journal (Refereed)
    Abstract [en]

    PURPOSE: We report our single-center experience of early and midterm outcome after endovascular repair of mycotic aortic aneurysms (MAA). METHODS: Case records were retrospectively reviewed of 11 patients who underwent endovascular repair of 13 MAAs between 2000 and 2007. The aneurysms were localized in the aortic arch in 1 patient, descending thoracic aorta in 4, suprarenal abdominal aorta in 3, and infrarenal abdominal aorta in 5. RESULTS: Mean follow-up was 27 months. A bleeding aortoesophageal fistula resulted in one in-hospital death <or=30 days. Three patients died later: one each of sepsis, stent migration that caused intestinal ischemia, and an unknown cause. Two patients had recurrent sepsis postoperatively but no vascular complications, two had elevated inflammatory markers during follow-up but were asymptomatic, and three patients had an uneventful follow-up. CONCLUSIONS: Endovascular treatment for MAA was feasible, with acceptable perioperative mortality and midterm outcome in this single-center case series. Recurrent sepsis and late relapse with a second MAA occurred, indicating the need of long-term antibiotic therapy and follow-up, as well as the possible need for secondary open repair in selected cases. Further research is warranted to evaluate long-term outcome.

  • 9.
    Sörelius, Karl
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Vascular Surgery.
    Mani, Kevin
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Vascular Surgery.
    Björck, Martin
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Vascular Surgery.
    Sedivy, Petr
    Wahlgren, Carl-Magnus
    Taylor, Peter
    Clough, Rachel E.
    Lyons, Oliver
    Thompson, Matt
    Brownrigg, Jack
    Ivancev, Krassi
    Davis, Meryl
    Jenkins, Michael P.
    Jaffer, Usman
    Bown, Matt
    Rancic, Zoran
    Mayer, Dieter
    Brunkwall, Jan
    Gawenda, Michael
    Koelbel, Tilo
    Jean-Baptiste, Elixene
    Moll, Frans
    Berger, Paul
    Liapis, Christos D.
    Moulakakis, Konstantinos G.
    Langenskiold, Marcus
    Roos, Hakan
    Larzon, Thomas
    Pirouzram, Artai
    Wanhainen, Anders
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Vascular Surgery.
    Endovascular Treatment of Mycotic Aortic Aneurysms A European Multicenter Study2014In: Circulation, ISSN 0009-7322, E-ISSN 1524-4539, Vol. 130, no 24, p. 2136-2142Article in journal (Refereed)
    Abstract [en]

    Background-Mycotic aortic aneurysm (MAA) is a rare and life-threatening disease. The aim of this European multicenter collaboration was to study the durability of endovascular aortic repair (EVAR) of MAA, by assessing late infection-related complications and long-term survival. Methods and Results-All EVAR treated MAAs, between 1999 and 2013 at 16 European centers, were retrospectively reviewed. One hundred twenty-three patients with 130 MAAs were identified. Mean age was 69 years (range 39-86), 87 (71%) were men, 58 (47%) had immunodeficiency, and 47 (38%) presented with rupture. Anatomic locations were ascending/arch (n=4), descending (n=34), paravisceral (n=15), infrarenal aorta (n=63), and multiple (n=7). Treatments were thoracic EVAR (n=43), fenestrated/branched EVAR (n=9), and infrarenal EVAR (n=71). Antibiotic was administered for mean 30 weeks. Mean follow-up was 35 months (range 1 week to 149 months). Six patients (5%) were converted to open repair during follow-up. Survival was 91% (95% confidence interval, 86% to 96%), 75% (67% to 83%), 55% (44% to 66%), and 41% (28% to 54%) after 1, 12, 60, and 120 months, respectively. Infection-related death occurred in 23 patients (19%), 9 after discontinuation of antibiotic treatment. A Cox regression analysis demonstrated non-Salmonella-positive culture as predictors for late infection-related death. Conclusions-Endovascular treatment of MAA is feasible and for most patients a durable treatment option. Late infections do occur, are often lethal, and warrant long-term antibiotic treatment and follow-up. Patients with non-Salmonellapositive blood cultures were more likely to die from late infection.

  • 10.
    Sörelius, Karl
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Vascular Surgery.
    Mani, Kevin
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Vascular Surgery.
    Björck, Martin
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Vascular Surgery.
    Wanhainen, Anders
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Vascular Surgery.
    Endovascular treatment of mycotic aortic aneurysms: a paradigm shift2017In: Journal of Cardiovascular Surgery, ISSN 0021-9509, E-ISSN 1827-191X, Vol. 58, no 6, p. 870-874Article, review/survey (Refereed)
    Abstract [en]

    Treatment of mycotic aortic aneurysms (MAAs) composes a particularly difficult challenge. Open repair has been considered the gold standard, despite lack of evidence supporting its superiority compared with the emerging alternative endovascular aortic repair (EVAR). This review discusses the pros and cons of EVAR for MAAs by dissecting the three largest publications on MAAs, and concludes that there has been a paradigm shift in treatment of MAAs for the benefit of EVAR.

  • 11.
    Sörelius, Karl
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Vascular Surgery.
    Schiraldi, Luigi
    Lausanne Univ Hosp CHUV, Dept Plast Reconstruct & Hand Surg, Rue Bugnon 46, CH-1011 Lausanne, Switzerland.
    Giordano, Salvatore
    Turku Univ Hosp, Dept Plast & Gen Surg, Turku, Finland.
    Oranges, Carlo M.
    Basel Univ Hosp, Dept Plast Reconstruct Aesthet & Hand Surg, Basel, Switzerland.
    Raffoul, Wassim
    Lausanne Univ Hosp CHUV, Dept Plast Reconstruct & Hand Surg, Rue Bugnon 46, CH-1011 Lausanne, Switzerland.
    Di Summa, Pietro G.
    Lausanne Univ Hosp CHUV, Dept Plast Reconstruct & Hand Surg, Rue Bugnon 46, CH-1011 Lausanne, Switzerland.
    Reconstructive Surgery of Inguinal Defects: A Systematic Literature Review of Surgical Etiology and Reconstructive Technique2019In: In Vivo, ISSN 0258-851X, E-ISSN 1791-7549, Vol. 33, no 1, p. 1-9Article, review/survey (Refereed)
    Abstract [en]

    Background/Aim: This study aimed to evaluate the literature regarding surgical etiology demanding inguinal reconstructive surgery, associated reconstructive techniques and outcomes.

    Materials and Methods: A systematic literature search was performed according to the PRISMA statement between 1996-2016.

    Results: A total of 64 articles were included, comprising 816 patients. Two main subgroups of patients were identified: Oncological resections (n = 255, 31%), and vascular surgery (n = 538, 66%). Oncological resection inguinal defects were treated with pedicled myocutaneous flaps (n = 166, 65%), fasciocutaneous flaps (77, 31%), muscle flaps (7, 3%) and direct closure (3, 1%). Vascular surgery complications were treated with muscle flaps (n = 513, 95%). Complications for the respective subgroup (oncological resections, vascular surgery) were: infection (24%, 14%), seroma (34%, 7.5%), flap dehiscence/delayed healing (20.6%, 40.8%,). The total reintervention rate was 20%.

    Conclusion: Reconstruction of inguinal defects should be addressed on a case-by-case basis. Myocutaneous flaps were favoured after oncological resections, while muscle flaps were preferred after vascular surgery.

  • 12.
    Sörelius, Karl
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Vascular Surgery.
    Sundbom, Magnus
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Upper Abdominal Surgery.
    Mani, Kevin
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Vascular Surgery.
    Wanhainen, Anders
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Vascular Surgery.
    Hybrid treatment of a post-EVAR aortoenteric fistula2014In: Vascular, ISSN 1708-5381, E-ISSN 1708-539X, Vol. 22, no 5, p. 385-389Article in journal (Refereed)
    Abstract [en]

    This report presents a case of secondary aortoenteric fistula after endovascular aortic repair in a fragile patient: The fistula developed due to aneurysm shrinkage and remodeling of the stent graft, resulting in a kink eroding through the aneurysm wall into the duodenum. The aortoenteric fistula was successfully treated with a hybrid procedure with endovascular aortic repair, followed by open enteroraphy and omental flap coverage of the stent graft and local antibiotic irrigation. Despite the presence of the stent graft in a previously infected field, the patient has recovered from the acute event with no septic recurrence or hemorrhage during four years of follow-up.

  • 13.
    Sörelius, Karl
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Vascular Surgery.
    Svensson, J.
    Umea Univ, Dept Surg & Perioperat Sci, Surg, Umea, Sweden;Umea Univ, Umea Sch Business Econ & Stat, Dept Stat, Umea, Sweden.
    Matthiessen, P.
    Orebro Univ, Fac Med & Hlth, Dept Surg, Orebro, Sweden.
    Rutegard, J.
    Umea Univ, Dept Surg & Perioperat Sci, Surg, Umea, Sweden.
    Rutegard, M.
    Umea Univ, Dept Surg & Perioperat Sci, Surg, Umea, Sweden;Umea Univ, Wallenberg Ctr Mol Med, Umea, Sweden.
    A nationwide study on the incidence of mesenteric ischaemia after surgery for rectal cancer demonstrates an association with high arterial ligation2019In: Colorectal Disease, ISSN 1462-8910, E-ISSN 1463-1318, Vol. 21, no 8, p. 925-931Article in journal (Refereed)
    Abstract [en]

    Aim

    The incidence of mesenteric ischaemia after resection for rectal cancer has not been investigated in a population‐based setting. The use of high ligation of the inferior mesenteric artery might cause such ischaemia, as the bowel left in situ depends on collateral blood supply after a high tie.

    Method

    The Swedish Colorectal Cancer Registry was used to identify all patients subjected to an abdominal resection for rectal cancer during the years 2007–2017 inclusive. Mesenteric ischaemia within the first 30 postoperative days was recorded, classified as either stoma necrosis or colonic necrosis. Multivariable logistic regression was used to estimate odds ratios (ORs) with 95% confidence intervals (CIs) for mesenteric ischaemia in relation to high tie, with adjustment for confounding.

    Results

    Some 14 657 patients were included, of whom 59 (0.40%) had a reoperation for any type of mesenteric ischaemia, divided into 34 and 25 cases of stoma necrosis and colonic necrosis, respectively. Compared with patients who did not require reoperation for mesenteric ischaemia following rectal cancer surgery, the proportion having high tie was greater (54.2% vs 38.5%; P = 0.032). The adjusted OR for reoperation due to any mesenteric ischaemia with high tie was 2.26 (95% CI 1.34–3.79), while the corresponding estimates for stoma and colonic necrosis, respectively, were 1.60 (95% CI 0.81–3.17) and 3.69 (95% CI 1.57–8.66).

    Conclusion

    The incidence of reoperation for mesenteric ischaemia after abdominal resection for rectal cancer is low, but the use of a high tie might increase the risk of colonic necrosis demanding surgery.

  • 14.
    Sörelius, Karl
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Vascular Surgery.
    Wanhainen, Anders
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Vascular Surgery.
    Acosta, S
    Svensson, M
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Vascular Surgery.
    Djavani-Gidlund, Khatereh
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Vascular Surgery.
    Björck, Martin
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Vascular Surgery.
    Open Abdomen Treatment after Aortic Aneurysm Repair with Vacuum-assisted Wound Closure and Mesh-mediated Fascial Traction2013In: European Journal of Vascular and Endovascular Surgery, ISSN 1078-5884, E-ISSN 1532-2165, Vol. 45, no 6, p. 588-594Article in journal (Refereed)
    Abstract [en]

    OBJECTIVES:

    Open abdomen (OA) treatment is sometimes necessary after surgery for aortic aneurysm (AA), to prevent or treat abdominal compartment syndrome (ACS). A multicentre study evaluating vacuum-assisted wound closure (100-150 mmHg) and mesh-mediated fascial traction (VAWCM) was performed.

    METHODS:

    All patients treated with OA after AA repair (2006-2009) were prospectively registered at four centres; those treated <5 days were excluded. All surviving patients underwent a 1-year follow-up, including computed tomography (CT) examination.

    RESULTS:

    Among 1041 patients treated with open or endovascular repair of AA, 28 (2.9%) had OA treatment with VAWCM; another two had VAWCM after hybrid operations for thoraco-abdominal AA. Eighteen (60%) were operated on for rupture and 12 (40%) electively. Eight had suprarenal or thoraco-abdominal aneurysms. Eight (27%) died within 30 days, none due to OA-related complications. Four died before abdominal closure; primary delayed fascial closure was achieved in all survivors. One-year mortality was 50%. Ten (33%) had bowel ischaemia requiring bowel resection. Late potential OA-related infectious complications occurred in five (17%), all of whom first developed intestinal ischaemia: entero-atmospheric fistulae (two), graft infections (two), aorto-enteric fistula (one). One year follow-up with clinical evaluation and CT showed no signs of graft infection. Incisional hernias occurred in 9 of 15 patients (60%); only three were symptomatic.

    CONCLUSION:

    VAWCM provided high fascial closure rate after AA repair and long-term OA treatment. Infectious complications occur after intestinal ischaemia and prolonged OA treatment, and are often fatal. The poor prognosis among patients needing OA after AA surgery may be improved by using VAWCM, permitting earlier closure.

  • 15.
    Sörelius, Karl
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Vascular Surgery.
    Wanhainen, Anders
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Vascular Surgery.
    Furebring, Mia
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Infectious Diseases.
    Björck, Martin
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Vascular Surgery.
    Gillgren, Peter
    Mani, Kevin
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Vascular Surgery.
    Nationwide Study of the Treatment of Mycotic Abdominal Aortic Aneurysms Comparing Open and Endovascular Repair2016In: Circulation, ISSN 0009-7322, E-ISSN 1524-4539, Vol. 134, no 23, p. 1822-1832Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: -No reliable comparative data exist between open repair (OR) and endovascular repair (EVAR) for mycotic abdominal aortic aneurysms (MAAAs). This nationwide study assessed outcomes after OR and EVAR for MAAA in a population-based cohort.

    METHODS: -All patients treated for MAAAs in Sweden between1994-2014 were identified in the Swedish vascular registry. The primary aim was to assess survival after MAAA with OR and EVAR. Secondary aims were analyses of the rate of recurrent infections and reoperations, and time-trends in surgical treatment. Survival was analyzed using Kaplan-Meier and log-rank test. A propensity score weighted correction for risk factor differences in the two groups was performed, including the operation year to account for differences in treatment and outcomes over time.

    RESULTS: -132 patients were identified, (0.6% of all operated AAA in Sweden). Mean age was 70 years (SD 9.2), and 50 presented with rupture. Survival at 3-months was 86% (95% CI 80-92%), 1-year 79% (72-86%), and 5-years 59% (50-68%). The preferred operative technique shifted from OR to EVAR after 2001 (proportion EVAR 1994-2000 0%, 2001-2007 58%, 2008-2014 60%). Open repair was performed in 62 patients (47%); aortic resection and extra-anatomical bypass (n=7), in-situ reconstruction (n=50), patch plasty (n=3), and 2 patients died intraoperatively. EVAR was performed in 70 patients (53%); standard EVAR (n=55), fenestrated/branched EVAR (n=8), and visceral deviation with stent grafting (n=7); no deaths occurred intraoperatively. Survival at 3-months was lower for OR compared with EVAR (74% vs 96%, p<0.001), with a similar trend present at 1-year (73% vs 84%, p=0.054). A propensity score weighted risk-adjusted analysis confirmed the early better survival associated with EVAR. During median follow-up of 36 and 41 months for OR and EVAR, respectively, there was no difference in long-term survival (5-years 60 vs 58%, p=0.771), infection-related complications (18 vs 24%, p=0.439), or reoperation (21% vs 24%, p=0.650).

    CONCLUSIONS: -This study demonstrates a paradigm shift in treatment of MAAA in Sweden, with EVAR being the preferred treatment modality. EVAR was associated with improved short-term survival compared with OR, without higher associated incidence of serious infection-related complications or reoperations.

  • 16.
    Sörelius, Karl
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Vascular Surgery.
    Wanhainen, Anders
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Vascular Surgery.
    Mia, Furebring
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Infectious Diseases.
    Martin, Björck
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Vascular Surgery.
    Peter, Gillgren
    Mani, Kevin
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Vascular Surgery.
    Nationwide study demonstrates paradigm shift in treatment of mycotic abdominal aortic aneurysmsManuscript (preprint) (Other academic)
    Abstract [en]

    Background: Radical open surgery (OR) is considered gold standard for management of mycotic abdominal aortic aneurysms (MAAAs). Endovascular repair (EVAR) is a less invasive but controversial treatment option for MAAA because the stentgraft is implanted in an infected field, whilst recent reports indicate promising outcome. No reliable comparative data exists. This nationwide study assesses outcome after OR and EVAR for MAAA in a population-based cohort.

    Methods: All patients treated in Sweden for MAAAs 1994-2014 were identified in the Swedish vascular registry. Twenty-seven vascular units participated in data collection according to a predefined protocol. Survival was cross-matched with the population registry.

    Results: 132 patients with 144 MAAAs were identified, (0.6% of all operated AAA in Sweden). Median age was 70 years (SD 9.2), 51 were immunosuppressed, and 50 presented with rupture. Survival at 3-months was 86% (95% CI 80-92%), 1-year 79% (72-86%), and 5- years 59% (50-68%).

    The preferred operative technique shifted from OR to EVAR after 2001 (proportion EVAR 1994-2000 0%, 2001-2007 58%, 2008-2014 60%). Open repair was performed in 62 patients (47%); aortic resection and extra-anatomical bypass (n=7), in-situ reconstruction (n=50), patch plasty (n=3), and two died intraoperatively OR attempt. EVAR was performed in 70 patients (53%); standard EVAR (n=55), fenestrated/branched EVAR (n=8), and visceral deviation with stentgrafting (n=7).

    Survival at 3-months was inferior for OR compared to EVAR in Kaplan-Meier analysis (74% vs 96%, p<0.001), with a similar trend present at 1-year (73% vs 84%, p=0.054). A propensity score weighted risk-adjusted analysis confirmed the early survival benefit of EVAR. During follow-up (median OR 36, EVAR 41 months) there was no difference in long- term survival (5-years 60 vs 58%, p=0.771), infection-related complications (18 vs 24%, p=0.439), or reoperation (21% vs 24%, p=0.650). In a multivariable analysis OR was a significant risk factor for death at 3-months (odds ratio 6.96, p=0.004).

    Conclusion: This study demonstrates a paradigm shift in treatment of MAAA in Sweden, with EVAR being the preferred treatment modality. EVAR achieved improved short-term survival compared to OR, without increasing the risk of serious infection-related complications or reoperations.

  • 17.
    Sörelius, Karl
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Vascular Surgery.
    Wanhainen, Anders
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Vascular Surgery.
    Wahlgren, Carl-Magnus
    Karolinska Hosp, Dept Vasc Surg, Stockholm, Sweden.
    Langenskiöld, Marcus
    Sahlgrens Univ Hosp, Dept Hybrid & Intervent Surg, Unit Vasc Surg, Gothenburg, Sweden.
    Roos, Håkan
    Sahlgrens Univ Hosp, Dept Hybrid & Intervent Surg, Unit Vasc Surg, Gothenburg, Sweden.
    Resch, Timothy
    Skane Univ Hosp, Vasc Ctr, Malmo, Sweden.
    Vaccarino, Roberta
    Skane Univ Hosp, Vasc Ctr, Malmo, Sweden.
    Arvidsson, Bengt
    Linkoping Univ, Dept Thorac & Vasc Surg, Linkoping, Sweden;Linkoping Univ, Dept Med & Hlth Sci, Linkoping, Sweden.
    Gillgren, Peter
    Karolinska Inst, Sodersjukhuset, Dept Clin Sci & Educ, Stockholm, Sweden;Soder Sjukhuset, Dept Surg, Unit Vasc Surg, Stockholm, Sweden.
    Bilos, Linda
    Orebro Univ Hosp, Fac Med & Vasc Surg, Dept Cardiothorac & Vasc Surg, Orebro, Sweden.
    Pirouzram, Artai
    Orebro Univ Hosp, Fac Med & Vasc Surg, Dept Cardiothorac & Vasc Surg, Orebro, Sweden.
    Holsti, Mari
    Umea Univ Hosp, Dept Surg & Perioperat Sci Surg, Umea, Sweden.
    Mani, Kevin
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Vascular Surgery.
    Nationwide Study on Treatment of Mycotic Thoracic Aortic Aneurysms2019In: European Journal of Vascular and Endovascular Surgery, ISSN 1078-5884, E-ISSN 1532-2165, Vol. 57, no 2, p. 239-246Article in journal (Refereed)
    Abstract [en]

    Objective: Mycotic aortic aneurysms are rare, life threatening, and complex. This nationwide study aimed to assess outcome after repair of mycotic thoracic aortic aneurysms (MTAAs).

    Methods: Patients treated in Sweden for MTAAs between 2000 and 2016 were identified in the Swedish vascular registry (2010-16) and local patient registries (2000-09). Primary outcome was survival, and secondary outcomes included surgical strategy, rate of infection related complications (IRC), and re-operations.

    Results: Fifty-two patients (median age 71 +/- 8.1 years; 28 [54%] men, 13 [25%] ruptured) were identified (3.6% of all thoracic aortic aneurysm repairs in Sweden). Aneurysm location was aortic arch (n = 6; 11%), descending aorta (n = 42; 81%), and multiple locations (n = 4; 8%). Twenty-nine (56%) patients had positive cultures; the most prevalent agent was Staphylococcus aureus (n = 16; 31%). Operative techniques included thoracic endovascular aortic repair (TEVAR; n = 35 [67%]), fenestrated/branched TEVAR (n = 8; 15%), hybrid repair (n = 7; 14%), and open patch repair (n = 2; 4%). Survival was 92% (95% confidence interval [CI] 88-96) at 30 days, 88% (95% CI 84-93) at three months, 78% (73-84) at one year, and 71% (64-77) at five years. The mean follow up among survivors (> 90 days) was 45 months (range 4-216 months). Antibiotics were administered for a median of 15 weeks (range 0-220 weeks). IRCs occurred in nine patients (17%): sepsis (n = 3), graft infection (n = 3), recurrent mycotic aneurysm (n = 1), aorto-oesophageal/bronchial fistula (n = 2). Six (67%) IRCs were fatal; 80% occurred within the first year. Re-operations were performed in nine patients (17%).

    Conclusions: TEVAR was often used as treatment for MTAAs, with acceptable short- and long-term survival when compared with open cohorts in the literature. IRCs are of concern and warrant follow up and long-term antibiotic treatment.

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