Comparison of Open and Endovascular Surgery for the Treatment of the Infections of the Thoracic Aorta

Objectives: The purpose of the study was to compare the results of open and endovascular treatment for the infections of the thoracic aorta. Materials and Methods: Between 1993 and 2015, 1516 patients were treated in our institution for diseases of the thoracic and thoraco-abdominal aorta, including 49 for infection at the thoracic level. Twenty-six primitive mycotic aneurysms, 13 cases of infected thoracic aortic grafts and 10 cases of infected thoracic stentgrafts were operated. In this group a fistula with the esophagus and/or the bronchial tree was observed in 24 cases (49%). Results: In the group of the patients treated for mycotic aneurysm, 16 (61%) had an open surgical treatment with the replacement of the thoracic aorta with a silver impregnated prosthesis. In this group five procedures associated an esophageal repair and one pulmonary lobectomy were necessary. Peroperative mortality was 19% (three patients). The other ten patients (39%) were treated with ndovascular treatment (TEVAR) with antibiotic impregnated stentgrafts. In this group technical success was 100% in absence of perioperative deaths. After an average follow-up of 84±20 months, mortality was 25% (four patients) after open treatment (25%) and 10% after TEVAR (one patient). In the group of the prosthetic infections open surgical treatment was carried out in 17 patients with 11 procedures of associated visceral repair. TEVAR was carried out in six cases with a procedure of associated visceral repair. Perioperative mortality after open treatment was 30% (n¼5); no perioperative death was observed after TEVAR. After a follow-up of 61±28 months, mortality was 53% and 50% after open surgery and TEVAR, respectively; the rate of reintervention was 6% after open surgery and 33% after TEVAR. Conclusion: The infections of the thoracic aorta present a very high mortality in the event of fistula with the esophagus and/or the bronchial tree requiring an associated surgical treatment. In our series TEVAR gave a higher survival rate for the treatment of primitive mycotic aneurysms than for the infections of surgical grafts or of stentgrafts. In the event of prosthetic infection TEVAR was associated with a higher rate of reintervention.