88
Treatment
Table 36. Management of Aortic Mycotic Aneurysm:
Comparison of Resection and Extra-Anatomic
Reconstruction, In Situ Reconstruction, or
Endovascular Device Repair
Procedure Potential Indications*
Extra-anatomic reconstruction Infrarenal location with gross purulence, psoas or
retroperitoneal abscess, vertebral osteomyelitis,
inadequate response to antibiotic therapy, selected
aortoenteric fistulae
In situ reconstruction • Thoracic, suprarenal, infrarenal, or visceral location
• Selected aortoenteric fistulae
Endovascular device repair
Bridge procedure
‡
: hemodynamic instability,
uncontrolled bleeding, rupture or impending
rupture, selected patients with aortocentric fistulae,
patients who are not fit for open surgery
* Potential indication; must be individualized for each patient.
†
Polyester gras, rifampin-soaked or silver-coated; less experience reported with cryopreserved
arterial allogras or venous autogras.
‡
Bridge procedure, used to stabilize patients until device explantation and arterial reconstruction.
Adapted from: Wilson WR, Bower TC, Creager MA, et al. Vascular gra infections,
mycotic aneurysms, and endovascular infections: a scientific statement from the American
Heart Association. Circulation. 2016;134:e412-e460.
