Infectious thoracic
aortitis is a
rare disease, especially since the incidence of
syphilis and
tuberculosis has dropped in western countries. However, the risk to develop an infectious
aortitis and subsequent
mycotic aneurysm formation is still present, particularly in case of associated
endocarditis,
sepsis, and in immunosuppressive disorders. Moreover, the number of surgical and endovascular thoracic aortic repairs is continuously increasing, and infective graft complications are observed more frequently. Several etiopathogenetic factors may play a role in thoracic aortic and prosthetic
infections, including hematogenous seeding, local bacterial translocation, and iatrogenous contamination. Also, fistulization of the esophagus or the bronchial tree is commonly associated with these diseases, and it represents a critical event requiring a multidisciplinary management. Knowledge on underlying micro-organisms,
antibiotic efficacy, risk factors, and prevention strategies has a key role in the management of this spectrum of
infectious diseases involving the thoracic aorta. When the diagnosis of a
mycotic aneurysm or a prosthetic graft
infection is established, treatment is demanding, often including a number of surgical options. Patients are usually severely compromised by
sepsis, and in most cases they are considered unfit for surgery for general clinical conditions or local concerns. Thus, results of different therapeutic strategies for
infectious diseases of the thoracic aorta are still burdened with very high morbidity and mortality. In this manuscript, we review the literature regarding the main issues related to thoracic infectious
aortitis and aortic graft
infections, and we report our personal series of patients surgically treated at our institution for these conditions from 1993 to 2014.