Danish Nationwide Study on Surgical Treatment of Infective Native Abdominal Aortic Aneurysms

Rebecca A C Skov; Martin Lawaetz; Nikolaj Eldrup; Timothy A Resch; Karl Sörelius; Danish Academic Research Consortium for INAAs

doi:10.1016/j.ejvs.2023.11.006

Danish Nationwide Study on Surgical Treatment of Infective Native Abdominal Aortic Aneurysms

Eur J Vasc Endovasc Surg. 2023 Nov 7:S1078-5884(23)00893-6. doi: 10.1016/j.ejvs.2023.11.006. Online ahead of print.

Authors

Rebecca A C Skov¹, Martin Lawaetz², Nikolaj Eldrup³, Timothy A Resch³, Karl Sörelius³; Danish Academic Research Consortium for INAAs

Collaborators

Danish Academic Research Consortium for INAAs:
Kim Houlind⁴, Jes Lindholt⁵, Kristian Aldrup Bloksgaard⁶, Allan Kornmaaler Hansen⁶, Claudina Rudolph⁷, Jacob Budtz-Lilly⁷, Saeid Shahidi⁸, Annette Høgh⁹

Affiliations

¹ Department of Vascular Surgery, Rigshospitalet, Copenhagen, Denmark; Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark; Copenhagen Academy for Medical Education and Simulation (CAMES), Denmark. Electronic address: rebecca.andrea.conradsen.skov@regionh.dk.
² Department of Vascular Surgery, Rigshospitalet, Copenhagen, Denmark; Nordic Health Group, Copenhagen, Denmark.
³ Department of Vascular Surgery, Rigshospitalet, Copenhagen, Denmark; Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark.
⁴ Department of Vascular Surgery, Kolding Hospital, Denmark.
⁵ Department of Vascular Surgery, Odense University Hospital, Denmark.
⁶ Department of Vascular Surgery, Aalborg University Hospital, Denmark.
⁷ Department of Vascular Surgery, Aarhus University Hospital, Denmark.
⁸ Department of Cardiology and Vascular Surgery, Zealand University Hospital Roskilde, Denmark.
⁹ Department of Vascular Surgery, Viborg Regional Hospital, Denmark.

PMID: 37944790
DOI: 10.1016/j.ejvs.2023.11.006

Abstract

Objective: This study aimed to describe surgical trends, survival, and infection related complications (IRC) in a Danish cohort of patients with infective native aortic aneurysms (INAAs).

Methods: A retrospective nationwide cohort study including all patients in Denmark who were surgically treated for abdominal INAA between 2000 and 2020 was conducted. Patients were identified through the Danish vascular registry, Karbase, which is a database registering all patients treated with vascular surgery in Denmark. Subsequent data on clinical presentation, treatment, all cause mortality, and complications were obtained from the electronic patient charts.

Results: Seventy-five patients were included in the study, of whom 60 (80%) were male, with a median age of 69 (IQR 64, 75) years. Open surgical repair (OSR) was performed in 54 (72%) patients and endovascular aortic repair (EVAR) in 21 (28%). Median follow up was 52 (IQR 32, 103) months. Open repair was consistently the most frequent treatment modality throughout the study period, but EVAR became more frequent over time. The 30 day survival of the total cohort was 97% (94 - 100%). Kaplan-Meier survival estimates for the cohort were 92% (95% CI 85 - 98%), 80% (95% CI 71 - 91%), 63% (95% CI 52 - 78%), and 48% (95% CI 35 - 66%) at one, three, five and 10 years, respectively. Patients treated by EVAR had comparable long term survival to patients treated by OSR, with a hazard ratio of 0.35 (95% CI 0.10 - 1.22), but was associated with better short term survival up to five years. The most common cause of death was sepsis. Five (9%) OSR patients had IRC compared with one (5%) EVAR patient.

Conclusion: In this nationwide study of patients treated for abdominal INAA, an increasing number of patients were surgically treated during the study period. Patients treated by EVAR demonstrated long term survival comparable to OSR. The incidence of post-operative IRC was low. These results should be interpreted with caution and prospective registries are needed.

Keywords: Complications; Endovascular repair; Infective native aortic aneurysm; Mycotic aneurysm; Open repair; Survival.