Abstract
BACKGROUND: Mycotic aortic aneurysms (MAAs), or infective native aortic aneurysms, are rare, life-threatening infections with a high risk of rupture. Non-typhoidal Salmonella (NTS) species show a tropism for the diseased aorta in elderly, atherosclerotic patients, causing explosive growth poorly captured by conventional surveillance. Management is complex when the visceral/paravisceral aorta is involved, making open surgical repair (OSR) risky and requiring tailored endovascular aortic repair (EVAR). This review synthesises evidence on Salmonella-associated MAAs and introduces hyper-rapid progression (HRP) as an early imaging biomarker. CONCLUSIONS: Salmonella MAAs represent a high-velocity phenotype. We define HRP as progression from aortitis to saccular pseudoaneurysm (≥ 5 mm) within 7 days or rapid enlargement (≥ 5 mm or > 50%) within 72 hours despite antibiotics. HRP serves as a "red flag" for urgent mechanical stabilisation. While OSR is the gold standard, in anatomically complex or high-risk patients, complex EVAR with parallel grafts and an optimized radial sealing strategy (ORSS) offers a life-saving alternative. Prospective validation of HRP and its integration into imaging algorithms are needed to improve survival in this devastating condition.