Clinical Characteristics of Patients with Tuberculous-Infected Native Aortic Aneurysms and Risk Factors for Poor Outcomes Following Endovascular Repair: A Multicenter Retrospective Study

Background The rarity of tuberculous-infected native aortic aneurysms (INAA) limits clinical expertise in its diagnosis and management. This study was conducted to investigate the clinical characteristics of tuberculous INAAs and assess the risk factors for poor outcomes following endovascular aneurysm repair (EVAR). Materials and Methods Cases of tuberculous INAAs were retrospectively reviewed at three Chinese centers (2010–2022) after approval by the institutional review board. Patients with INAAs on thoracic aortas or abdominal aortas were included. ALL included patients underwent EVARs and received preoperative anti-tuberculosis (anti-TB) treatment. Primary outcomes were mortality and infection-related complications (IRCs), analyzed using Cox regression and logistic regression analysis. Results Among the 62 patients included (65.84 ± 10.91 years; 61.3% male), the rupture rate was 22.6%. Logistic regression analysis revealed irregular morphology (Odds Ratio [OR] 10.71; 95% CI 1.43–56.73, p = 0.021) and aneurysm diameter (OR 4.58; 95% CI 1.34–15.75, p = 0.016) as independent predictors of rupture. Postoperative IRCs occurred in 16 patients, of whom 81.25% (13/16) patients died during the 24-month follow-up. Logistic regression analysis revealed that perioperative anti-TB treatment (OR44.87, 95%CI 6.64–303.10; p = 0.002) and an elevated ESR (OR 8.79, 95%CI 1.50-51.45; p = 0.016) were risk factors for IRCs. Kaplan–Meier analysis revealed that the perioperative survival and 6-month, 12-month, and 24-month survival rates were 93.4%, 91.8%, 83.6% and 65.6%, respectively. Cox regression analysis revealed that rupture (HR 2.88, 95% CI 1.11–7.50; p = 0.030) and perioperative anti-TB treatment (HR 4.77, 95% CI 1.78–12.78; p = 0.002) were significant predictors of mortality. Conclusions Tuberculous INAAs are fatal disease with a high rupture rate. Irregular morphology and aneurysm diameter ≥ 5.2 cm predict rupture, warranting prompt surgical interventions. The therapeutic algorithm should be based on serum ESR, aneurysm diameter and morphology, and duration of preoperative anti-TB treatment.