Aortic Infections—A Narrative Review

Background: Infections involving the aorta are particularly complex, posing unique diagnostic and therapeutic challenges. Aortic infections (AIs) are associated with considerable morbidity and mortality and incur significant healthcare costs. This narrative review examines the current literature and offers guidance on primary and post-operative AIs. Methods: We conducted a search using electronic databases (PubMed, Medline, Scopus, and Cochrane) with a Boolean approach using selected keywords of aorta and infection, aortitis, aortic graft infection, infected aortic aneurysm, and mycotic aneurysm. Results: AIs are among the most feared complications in vascular surgery. Gram-positive bacteria, such as Staphylococcus aureus , are responsible for about 80% of AIs. These microorganisms produce toxins capable of leading to anastomotic disruption. The common use of broad-spectrum antibiotic agents has resulted in an increasing prevalence of multi-drug-resistant organisms, making the management of AIs even more complex. Clinical presentation is often non-specific, ranging from mild symptoms, such as abdominal pain, malaise, and fever, to sepsis and hemorrhagic shock due to anastomotic rupture. Management of patients with an infected aorta includes antimicrobial therapy and surgical source control, which may include washout and aneurysm repair if a primary aortic infection or graft removal if a post-operative infection. Collaboration with intensive care unit and ID consultation improved long-term outcomes. Conclusions: AIs are among the most complicated and challenging surgical problems and are potentially life-threatening and require a multi-disciplinary approach to reduce its prevalence and improve clinical outcomes.