. Author manuscript; available in PMC: 2023 Dec 13.

Published in final edited form as: J Am Coll Cardiol. 2022 Nov 2;80(24):e223–e393. doi: 10.1016/j.jacc.2022.08.004

TABLE 36.

Management of Aortic Mycotic Aneurysm: Comparison of Resection and Extra-Anatomic Reconstruction, In Situ Reconstruction, or Endovascular Device Repair

Procedure	Potential Indications^*	Advantages	Disadvantages
Extra-anatomic reconstruction	Infrarenal location with gross purulence, psoas or retroperitoneal abscess, vertebral osteomyelitis, inadequate response to antibiotic therapy, selected aortoenteric fistulae	Avoids placement of foreign body in infected area	Not technically feasible for thoracic, suprarenal, or visceral location or for emergency use Long operating time Long-term patency rates low Stump blowout Limb ischemia, amputation Reinfection rate higher than for in situ reconstruction Ischemic colitis
In situ reconstruction	Thoracic, suprarenal, infrarenal, or visceral location Selected aortoenteric fistulae	More versatile than extra-anatomic: fewer long-term complications, higher patency rates, lower recurrent infection rate, shorter operating time Polyester grafts^† available for emergency surgery	Theoretical risk of infection because of interposition of foreign material in infected site
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	Emergency stabilization Low early morbidity, mortality Less invasive No cross-clamping of aorta: spinal cord injury, reperfusion injury	Persistent infections and device infections Higher long-term morbidity, mortality with device retention Requires device explanation, reconstruction

Potential indication; must be individualized for each patient.

^†

Polyester grafts, rifampin-soaked or silver-coated; less experience reported with cryopreserved arterial allografts or venous autografts.

^‡

Bridge procedure, used to stabilize patients until device explanation and arterial reconstruction.