Background: Infected native aortic aneurysm (INAA) is an uncommon but life-threatening vascular infection characterized by rapid progression, diagnostic uncertainty, and substantial mortality.Despite advances in imaging and endovascular therapy, evidence remains fragmented, and reporting standards vary widely.This systematic review and meta-analysis provide a comprehensive contemporary synthesis of INAA, evaluating diagnostic definitions, clinical practices, microbiology, and outcomes.Methods: Databases including PubMed, Embase, Scopus, Web of Science, and Cochrane CENTRAL were searched from inception to January 2025.Studies reporting 3 INAA cases were included.Data extracted included diagnostic definitions, microbial profiles, operative strategies, mortality, and reintervention.Random-effects meta-analyses estimated pooled proportions for early mortality and reintervention.Subgroup analyses compared open repair and EVAR and examined the influence of culture-negative presentation.Results: Sixty-three studies met the eligibility criteria.Diagnostic definitions were highly heterogeneous: most studies used author-defined criteria, two applied Delphi-based definitions, and several misapplied prosthetic graft infection frameworks.Across 33 studies (n=899), pooled early mortality was 20.3% (95% CI 15.0-26.9%;I = 67.6%).Across 31 studies (n=869), pooled reintervention was 12% (95% CI 9-16%; I = 35.2%).No statistically significant difference in early mortality was observed between open repair and EVAR.Culture-negative disease ranged from 0-80%, with no significant association with early mortality.Marked geographic variation in microbiology was observed, with Salmonella predominating in Asian cohorts and broader pathogen diversity in Western series. J o u r n a l P r e -p r o o fConclusions: Infected native aortic aneurysm remains a rare but highly lethal condition with substantial early mortality and reintervention.Although no statistically significant early mortality difference was observed between open and endovascular repair, interpretation is limited by heterogeneity and follow-up differences.Geographic variation in microbiologic profiles was evident.Standardized reporting frameworks and collaborative prospective data collection are needed to improve risk stratification and long-term outcome assessment.
Aimanan et al. (2026) studied this question.