Background
The surgical management of infected aneurysms remains challenging and controversial.
We aimed to assess the results of our retrospective series of patients surgically
treated for infected infrarenal aortoiliac aneurysms and to verify our strategy.
Methods
Retrospective case review of a single center.
Results
Between January 1994 and December 2008, 545 patients with infrarenal aortoiliac aneurysms
underwent surgery at our institution. Among these cases, 13 (2.4%) were classified
as primary infected aneurysms. Seven were located in the infrarenal aorta and 6 were
located in the iliac artery. The identified pathogens were Salmonella species (n = 2), methicillin-resistant Staphylococcus aureus (n = 2), and others. Systemic antibiotics were administered preoperatively to control
septic conditions. At the time of surgery, 4 (31%) aneurysms had ruptured already.
All but 2 cases, which were treated with extra-anatomic bypass, were repaired in situ
using a Dacron graft. Although no in-hospital deaths occurred among the 3 patients
who underwent planned surgery after successful control of septic conditions, 4 of
8 patients who underwent emergency surgery under septic conditions died during the
early postoperative period. No signs of persistent or recurrent infection have been
observed in our surviving patients with a mean follow-up of 40 months.
Conclusion
Timely surgical intervention after controlling sepsis provided excellent outcomes,
whereas the mortality rate of patients with sepsis or rupture was still high. Debridement
of periaortic-infected tissue and in situ prosthetic graft repair are feasible.
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References
- Salmonellosis and mycotic aneurysm of the aorta. A report of 10 cases.J Infect. 1995; 30: 129-133
- Ruptured mycotic thoracoabdominal aortic aneurysms: a report of three cases and a systematic review.J Vasc Surg. 2001; 33: 861-867
- Mycotic aneurysms of the thoracic and abdominal aorta and iliac arteries: experience with anatomic and extra-anatomic repair in 33 cases.J Vasc Surg. 2001; 33: 106-113
- Infected aortic aneurysms: aggressive presentation, complicated early outcome, but durable results.J Vasc Surg. 2001; 34: 900-908
- Axillobifemoral bypass and aortic exclusion for vascular septic lesions: a multicenter retrospective study of 98 cases. French University Association for research in surgery.Ann Vasc Surg. 1992; 6: 119-126
- Surgical outcome of infectious aneurysm of the abdominal aorta with or without SIRS.Cardiovasc Surg. 2001; 9: 436-440
- Mycotic aneurysms—a challenge and a clue. Review of ten-year experience.Arch Intern Med. 1970; 126: 977-982
- One-stage operative therapy for salmonella mycotic abdominal aortic aneurysm.Ann Surg. 1974; 179: 8-11
- Salmonella arteritis—preoperative diagnosis and cure of salmonella typhimurium aortic aneurysm.N Engl J Med. 1969; 281: 310-312
- Infected infrarenal aortic aneurysms: when is in situ reconstruction safe?.J Vasc Surg. 1993; 17: 635-645
- Direct replacement of mycotic thoracoabdominal aneurysms.J Vasc Surg. 1993; 18: 477-485
- In situ prosthetic graft replacement for mycotic aneurysm of the aorta.Ann Thorac Surg. 1989; 47: 193-203
- Surgical treatment for primary infected aneurysm of the descending thoracic aorta, abdominal aorta, and iliac arteries.J Vasc Surg. 2002; 36: 746-750
- Surgical treatment of infected aneurysms and pseudoaneurysms of the thoracic and abdominal aorta.Am J Surg. 2005; 189: 150-154
- The Gulstonian lectures on malignant endocarditis.Br Med J. 1885; 1: 467-470
- Outcome after endovascular stent graft treatment for mycotic aortic aneurysm: a systematic review.J Vasc Surg. 2007; 46: 906-912
- Endovascular management of mycotic aortic aneurysms and associated aortoaerodigestive fistulas.Ann Vasc Surg. 2009; 23: 81-89
- Treatment of mycotic aneurysm of the aorta and its branches: the location determines the operative technique.Eur J Vasc Surg. 1992; 6: 419-423
- Mycotic aneurysms of the suprarenal abdominal aorta: prolonged survival after in situ aortic and visceral reconstruction.J Vasc Surg. 1989; 10: 635-641
- In situ prosthetic graft replacement for mycotic thoracoabdominal aneurysms.Am Surg. 1996; 62: 35-39
- Arterial infections in the new millenium: an old problem revisited.Ann Vasc Surg. 2006; 20: 590-595
- Arterial reconstruction with cryopreserved human allografts in the setting of infection: a single-center experience with midterm follow-up.J Vasc Surg. 2009; 49: 660-666
- Autologous superficial femoral vein for aortic reconstruction in infected fields.Ann Vasc Surg. 1999; 13: 32-36
Article info
Publication history
Published online: March 24, 2011
Accepted:
December 24,
2010
Identification
Copyright
© 2011 Mosby, Inc. Published by Elsevier Inc. All rights reserved.
