Infective Native Aortic Aneurysm: A Contemporary Clinical Review

Background: Infective native aortic aneurysm (INAA) is an uncommon but lethal disorder caused by microbial destruction of the aortic wall. Objective: To summarize current evidence on epidemiology, pathogenesis, clinical presentation, diagnosis, microbiology, and treatment of INAA. Methods: This narrative review synthesizes recent English-language literature and key consensus documents relevant to native aortic infection. Results: INAAs account for approximately 0.6–3% of aortic aneurysms in Western series, with higher proportions in East Asia. Staphylococcus aureus, Streptococcus species, and non-typhoidal Salmonella are the dominant pathogens, although gram-negative bacilli, anaerobes, mycobacteria, and fungi are occasionally encountered. Presentation is often nonspecific, with fever, chest, back, or abdominal pain, and systemic inflammatory response. Contrast-enhanced computed tomography is the first-line imaging test; magnetic resonance imaging and fluorodeoxyglucose positron emission tomography/computed tomography are useful adjuncts when diagnosis or treatment response is uncertain. Management requires prompt broad-spectrum antibiotics followed by prolonged pathogen-directed therapy and definitive aortic exclusion or excision. Open reconstruction offers the most reliable source control, whereas endovascular repair reduces initial operative stress but leaves infected tissue in situ and therefore carries a greater risk of persistent or recurrent infection. Conclusions: Outcomes depend on early recognition, immediate antimicrobial therapy, and timely selection of open, endovascular, or staged hybrid treatment. Because delayed diagnosis remains common and evidence is largely observational, management should be individualized in a multidisciplinary aortic infection team.