Orellana Davila Bernardo, Mancusi Carlotta, Coscarella Carlo, Spataro Claudio, Carfagna Paolo, Ippoliti Arnaldo, Giudice Rocco, Ferrer Ciro
Vascular and Endovascular Surgery Unit, San Giovanni-Addolorata Hospital, 00184 Rome, Italy.
Clinical Medicine and Infectious Diseases Unit, San Giovanni-Addolorata Hospital, 00184 Rome, Italy.
J Clin Med. 2024 Aug 9;13(16):4669. doi: 10.3390/jcm13164669.
Aortitis is a rare inflammation of the aorta. It can be classified as infective, non-infective, or idiopathic. Infective aortitis can debut as an acute aortic syndrome that needs urgent or emergent treatment. Historically, these kinds of patients have been preferably treated by open surgery, with subsequent lack of information about the endovascular repair. The aim of the present study is to report the results of our experience with the urgent or emergent endovascular repair of infective aortitis with acute presentation. All consecutive urgent or emergent endovascular repairs, performed between January 2019 and January 2024 for the treatment of infective aortitis, were included. The inclusion criteria were clinical, laboratory, and radiological findings recognized as aortitis risk factors. Patients with graft or endograft infection, aortic fistulae, and mycotic aneurysm were excluded. Primary endpoints were technical success and 30-day and follow-up survival. Early and late major adverse events, any changes in lesion morphology over time, and need for re-intervention were also assessed. A total of 15 patients (14 males and 1 female) with a mean age of 74.2 ± 8.3 were included. All the subjects were treated by endovascular means in an urgent or emergent setting because of a rapidly growing aneurysm, symptomatic lesion, or contained or free aortic rupture. The diagnosis of infective aortitis was confirmed postoperatively by positive blood cultures in all the patients. A rapidly growing or symptomatic lesion was noted in all 15 subjects. Among these there were six (40%) contained and two (13%) free aneurysm ruptures. The endovascular techniques performed were as follows: four thoracic-EVAR (TEVAR), three off-the-shelf branched-EVAR (BEVAR), one Chimney-EVAR (Ch-EVAR), six EVAR with bifurcated graft, and one EVAR with straight tube graft. Technical success was achieved in 100% of the patients. Two patients (13%) died within 30 days after the index procedure. No case of early aortic-related mortality was registered. During a mean follow-up of 31.6 ± 23.1 months (range 1-71), no further death or major adverse event was registered among the remaining 13 alive patients. Re-interventions were performed in three cases (20%). Aneurysm's shrinkage > 5 mm or stability was noted in 10 of the 13 patients who survived the early period after repair. Despite the relative reluctance to use an endograft in an infected area, in our experience the endovascular approach resulted to be feasible, safe, and effective in the treatment of infective aortitis with acute presentation, with acceptable peri-operative and mid-term follow-up outcomes. Further studies are needed to confirm our results.
主动脉炎是一种罕见的主动脉炎症。它可分为感染性、非感染性或特发性。感染性主动脉炎可表现为急性主动脉综合征，需要紧急或急诊治疗。从历史上看，这类患者最好通过开放手术治疗，随后缺乏有关血管腔内修复的信息。本研究的目的是报告我们对急性表现的感染性主动脉炎进行紧急或急诊血管腔内修复的经验结果。纳入了2019年1月至2024年1月期间为治疗感染性主动脉炎而进行的所有连续紧急或急诊血管腔内修复。纳入标准为临床、实验室和影像学检查结果被确认为主动脉炎危险因素。排除有移植物或腔内移植物感染、主动脉瘘和真菌性动脉瘤的患者。主要终点为技术成功、30天生存率和随访生存率。还评估了早期和晚期主要不良事件、病变形态随时间的任何变化以及再次干预的必要性。共纳入15例患者（14例男性和1例女性），平均年龄为74.2±8.3岁。所有受试者均因动脉瘤快速生长、有症状病变或主动脉局限性或游离性破裂而在紧急或急诊情况下接受血管腔内治疗。所有患者术后血培养阳性确诊为感染性主动脉炎。所有15例受试者均有快速生长或有症状的病变。其中有6例（40%）为局限性动脉瘤破裂，2例（13%）为游离性动脉瘤破裂。所采用的血管腔内技术如下：4例胸主动脉腔内修复术（TEVAR）、3例即用型分支腔内修复术（BEVAR）、1例烟囱式腔内修复术（Ch-EVAR）、6例使用分叉移植物的腔内修复术和1例使用直管移植物的腔内修复术。100%的患者实现了技术成功。2例患者（13%）在首次手术后30天内死亡。未记录到早期与主动脉相关的死亡病例。在平均31.6±23.1个月（范围1 - 71个月）的随访期间，其余13例存活患者中未再记录到死亡或主要不良事件。3例患者（20%）进行了再次干预。在修复后早期存活的13例患者中，有10例动脉瘤缩小>5mm或保持稳定。尽管相对不愿意在感染区域使用腔内移植物，但根据我们的经验，血管腔内治疗方法在治疗急性表现的感染性主动脉炎方面是可行、安全且有效的，围手术期和中期随访结果可接受。需要进一步研究来证实我们的结果。
