Brucella-induced aorto-iliac aneurysms (with < 200 documented cases globally) present unique therapeutic challenges due to their dual pathology of structural fragility and persistent bacteremia. Despite their life-threatening nature, no consensus exists on optimal management, particularly for patients unsuitable for open surgical reconstruction. This single-center case series provides critical insights into endovascular salvage strategies for this orphan disease. A retrospective analysis was conducted on 16 consecutive patients with Brucella-infected aorto-iliac aneurysms undergoing endovascular aneurysm repair (EVAR) with adjunctive local and systemic antimicrobial therapy at our institution between January 2019 and June 2025. The cohort demonstrated a 30-day mortality rate of 6.3% (1/16) and all-cause mortality of 31.3% (5/16) during a mean follow-up of 31.1 months. Notably, one patient (6.3%) without local gentamicin-fibrin sealant application developed distal aneurysm recurrence leading to fatal hematemesis at 48 months. In this cohort, Three patients died as a consequence of self-discontinuation of antibiotic therapy: two patients (12.5%) succumbed to infectious shock, while one patient experienced fatal aneurysm recurrence and rupture. Among 15 patients receiving standardized protocol (EVAR with intracavitary gentamicin instillation and prolonged antimicrobial therapy), satisfactory aortic remodeling was achieved with significant aneurysm diameter reduction (39.7 vs. 44.5 mm, P < 0.01). Reintervention rate was 6.3% (1 / 16) for iliac occlusion. Although radical open repair with complete debridement should remain the preferred approach for physiologically eligible patients, our findings suggest that EVAR combined with intracavitary antibiotic delivery and rigorously monitored antimicrobial therapy may be a viable alternative in select cases. This hybrid strategy requires meticulous patient selection, sustained infection control, and strict therapeutic compliance to mitigate long-term reinfection risks. Not applicable.
Zhang et al. (Tue,) studied this question.