Outcomes of infective aneurysm repairs in the New Zealand thoracic stent database.

BACKGROUND: Infective thoracic aneurysms are rare and have a poor prognosis. In the past, these have been managed surgically with adjunctive antibiotic therapy. Endoluminal repair is a relatively new treatment option which may be associated with lower morbidity and mortality. METHODS: The New Zealand Thoracic Aorta Stent graft registry was interrogated between December 2001 and September 2009, selecting all patients with endoluminal repair of infective thoracic aortic aneurysms. RESULTS: Out of 184 patients on the database, four (2.2%) patients (male = 3, median age = 72) underwent endoluminal repair of an infective thoracic aortic aneurysm. The aneurysm was successfully excluded at the time of the procedure in all patients. There was a low incidence of post-procedural complications including atrial fibrillation (n = 1), pneumonia with haemoptysis (n = 1), urinary retention (n = 1) and access site seroma (n = 1). Time to discharge was mean of 26.5 days, median 22.5 days (8­53 days). One of the four patients is still alive and well at the time of reporting. Of the remaining three patients, mean survival is 486 days, median 374 days (336­748 days). CONCLUSIONS: Endoluminal repair is a treatment option for infective thoracic aneurysms, but the durability is unknown. Due to the rareness of the condition, a randomized clinical trial is unlikely to succeed. National registries such as the New Zealand Thoracic Aortic Stent provide useful information regarding this.

Treatment delays for patients exiting an aortic aneurysm surveillance programme.

BACKGROUND: We have previously reported abdominal aortic aneurysm (AAA)-related mortality in patients who have completed surveillance. This study investigates the journey time of patients who exited the AAA surveillance programme at Christchurch Hospital and underwent elective repair to determine the factors contributing to the interval between completing surveillance and undergoing surgical repair. METHODS: A retrospective review of patient notes was carried out for 25 patients who underwent elective repair of their AAA after exiting the surveillance programme between November 2000 and September 2005. RESULTS: The median time interval between exiting the programme and undergoing repair for patients fit for repair was 6 months. During this waiting period, there were two aneurysm-related deaths. Analysis of the patient journeys showed that those with significant comorbidity, that is, patients who required additional investigation by other clinicians (n = 7), had a median time to repair of 35 weeks. This was substantially increased compared with a median time of 22.5 weeks to repair for the rest (n = 18). CONCLUSION: At our institution the median time for completion of surveillance to repair was 6 months. An AAA with a diameter of 55 mm has an expected risk of rupture of 5%, with mortality approaching 90%. In our series, mortality was 4.9% (two patients died while awaiting repair), consistent with expected figures. Factors contributing to this delay of 6 months to repair were identified. Modifications to this journey are suggested to improve the time interval and therefore hopefully reduce the aneurysm-related mortality in this group.