Mycotic subclavian artery aneurysms: a scoping review

Introduction:
Mycotic subclavian artery aneurysms (SAAs) are a very rare disorder.

Aim:
To provide an overview of current knowledge on clinical features, management strategies and outcome evaluations of mycotic SAAs.

Material and methods:
The study materials were based on comprehensive literature retrieval of publications of mycotic SAAs published between 2000 and 2023.

Results:
Contaminated mechanical injuries and abscess erosions of the arterial walls are mechanisms of mycotic SAAs. The diagnosis relies on detection of pathogenic microorganisms by cultures or microbiological investigations of blood, other fluids and infected tissues as well as medical imaging visualization. The indications for an interventional therapy were poor general condition, high surgical risk, and rescue exclusion for a ruptured pseudoaneurysm. Three (9.1%) pre-treatment deaths were a result of sudden rupture of the mycotic SAAs and thus they lost the opportunity of treatment. All post-treatment deaths occurred in the interventional patient group, whereas the causes of death seemed to be unrelated to mycotic SAAs per se or to treatments of choice. Patient outcome evaluations revealed no significant difference between different treatments of choice. No significant predictive risk factors were responsible for patient outcomes.

Conclusions:
Once a diagnosis of mycotic SAA is made, sensitive antibacterial drugs are applied immediately to control the infection and control aneurysmal progression. Early treatment is conducted as soon as possible to avoid aneurysmal rupture. A decision on treatment of choice is made based on the patient’s specific condition. Antibacterial drug use is continued for about 6 weeks after surgical or interventional therapy.