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

OBJECTIVES: 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 2000 - 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 which 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%) patients. 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 1, 3, 5 and 10 years, respectively. Patients treated with EVAR had comparable long term survival to patients treated with OSR, with a hazard ratio of 0.35 (95% CI 0.10 - 1.22), but was associated with better short term survival up to 5 years. The most common cause of death was sepsis. Five (9%) OSR patients had IRC compared with one (5%) EVAR patient.

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