Infective native visceral artery aneurysm (INVAA): A systematic review of etiology,treatment,and outcomes

Abstract

The present review introduces the term ‘infective native visceral artery aneurysm (INVAA)’ and provides a systematic review of the literature on this topic. The terms ‘mycotic’ and ‘infected’ have been replaced by the term ‘infective native’ to more accurately describe aneurysms of this type. A systematic search of MEDLINE, Embase, Google Scholar, and Scopus databases was performed to identify articles reporting on INVAAs to April 2024. Inclusion criteria encompassed studies describing ‘mycotic’ or ‘infected’ primary visceral aneurysms, excluding patients with concurrent aneurysms in the aorta. The search yielded 356 articles, with 161 meeting the inclusion criteria, covering 175 patients. The median age was 48 years (IQR: 33–60 years), predominantly men (n = 127, 72.6%). INVAA was most frequently reported in the superior mesenteric artery (37.5%, n = 65), followed by the hepatic (22.9%, n = 40) and splenic arteries (14.3%, n = 25). Endocarditis was the predominant etiology in 67.4% (n = 118) of cases. Gram-positive pathogens were identified in 58.8% (n = 103) of cases. Treatment modalities included open surgery (49.7%, n = 87), endovascular interventions (37.7%, n = 66), and medical management (12.0%, n = 21). The overall proportion of patients who died was 13.7% (n = 24). In multivariable modeling, cerebral aneurysms (OR: 4.0, 95% CI 1.17, 12.8; p = 0.02), gastrointestinal bleed (OR: 5.79, 95% CI 1.86, 17.6; p < 0.01), and chronic kidney disease (OR: 16.0, 95% CI 2.3, 136; p < 0.01) were associated with increased odds of death. The optimal treatment for INVAA remains undefined, highlighting the need for standardization of reporting and prospective registries to enhance the understanding and management of this complex disease.