Endovascular repair combined with adjunctive procedures in the treatment of tuberculous infected native aortic aneurysms

Abstract

Objective: The present study aimed to analyze the experience of a single center and assess the efficacy and durability of endovascular aortic repair (EVAR) in patients with tuberculous infected native aortic aneurysms (INAAs).

Methods: All patients who underwent EVAR for INAAs between September 2014 and August 2021 were reviewed retrospectively. The primary end points were 30-day and overall mortality rates; the secondary outcomes included major complications, endoleak, recurrence, reintervention rate, and thrombosis of the pseudoaneurysmal sac.

Results: A total of 18 patients (average age, 61.3 years; 10 female [55.6%]) were identified. Fifteen patients (83.3%) had adjunctive procedures. Both the in-hospital and 30-day mortality rates were 0%. The overall cumulative survival rates estimated by Kaplan-Meier were 100% at 1 and 6 months, and 92.3% at 12 and 24 months, and 80.8% at 36 and 48 months. Type Ib and II endoleaks each occurred in 1 patient (5.6%) and resolved without treatment after 1 month. No graft infections, strokes, paraplegia, ischemic abdominal complications, or other major complications occurred. The overall rates of cumulative freedom from recurrence of aneurysm and reintervention were 83.9% and 81.8%, respectively, during the median follow-up period of 28.5 months (range, 1-72 months). The median time of administering antituberculosis drugs was 10.5 months (range, 2-44 months).

Conclusions: EVAR combined with oral antituberculosis medication is effective and may be an appealing treatment option for patients with high-risk INAAs. Adjunctive procedures, including targeted drug delivery to the site of infection, could be a solution to further controlling the infection, but still needs further evaluation.

Keywords: Antituberculosis chemotherapy; Endovascular aortic repair; Pseudoaneurysm; Tuberculosis; Tuberculous infected native aortic aneurysms.