IYSC07 - Safety and Efficacy of Physician Modified Endografts (PMEG) in the Emergency Management of Native Infectious Aortitis: A Retrospective Single-Center Study

Objectives: Native infectious aortitis represents a rare clinical condition often associated with rapid aneurysmal growth and a high risk of rupture, requiring prompt and multidisciplinary treatment. The advent of endovascular techniques has expanded therapeutic possibilities, especially with the introduction of Physician Modified EndoGrafts (PMEG), which offer a safe and customizable option even in emergency settings. The aim of this study was to retrospectively evaluate the short- and mid-term outcomes of patients with infectious aortitis treated with PMEG combined with adapted antibiotic therapy.

Methods: The study included all patients diagnosed with native infectious aortitis involving the paravisceral aorta, who were referred to our tertiary hospital center and treated in emergency settings with PMEG between January 2015 and September 2024. All patients were subsequently evaluated and managed by a Multidisciplinary Vascular Infection Team and underwent targeted antibiotic therapy. The primary endpoints of the study were technical success (aneurysmal exclusion) and in-hospital mortality, while overall survival, complication rates, and reinterventions were analyzed during follow-up.

Results: A total of 21 patients were treated in emergency settings for native infectious paravisceral aortitis. Among these, 11 patients (53%) were treated with PMEG (6/11 males) with a mean age of 71 years (range 47–82). Technical success was achieved in all patients. In 4/11 cases, a postoperative percutaneous abscess drainage was performed to identify the causative microorganism. The time to discharge was 19.4 days (range 10–28). Early endoleaks occurred in 4 patients (3 type Ia, 1 type Ic), all of which required relining. No in-hospital deaths were recorded. Follow-up was achieved in all patients, with a mean duration of 17 months (range 3–38). During follow-up, two non-aneurysm-related deaths were reported. Two endovascular reinterventions were performed to address type Ib endoleaks, with no patient requiring open surgical reintervention. The mean duration of postoperative antibiotic therapy was 10.9 months (range 3–26).

Conclusions: In our experience, the multidisciplinary approach using PMEG combined with targeted antibiotic therapy proved to be safe and effective in the treatment of infectious aortitis in emergency settings. This technique provided satisfactory short- and mid-term outcomes, offering a viable alternative for complex anatomies without the need for open surgical reinterventions. However, further studies are necessary to confirm the long-term efficacy of PMEG in the management of this condition in larger wide numbers of patients.