Surgery for Infected Aneurysm of the Aortic Arch
Resource
JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY v.134 n.5 pp.1157-1162
Journal
JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY
Journal Volume
v.134
Journal Issue
n.5
Pages
1157-1162
Date Issued
2007
Date
2007
Author(s)
HSU, RON-BIN
Abstract
Objective: Infected aneurysm of the aortic arch is rare and can be fatal without surgery. We report our surgical experience with infected aneurysms of the aortic arch. Method: We conducted a retrospective chart review. Results: Between 1995 and 2006, 10 patients with infected aneurysms of the aortic arch were treated at our hospital. There were 8 men with a median age of 67.5 years (range, 50 - 79 years) . The most common pathogen was nontyphoid Salmonella in 5 ( 50%) patients, followed by Staphylococcus aureus in 2 patients. The site of infection was the aortic arch at the level of the brachiocephalic artery in 1, the left common carotid artery in 4, and the left subclavian artery in 5 patients. All patients underwent in situ graft replacement under deep hypothermic circulatory arrest. There was 1 (10%) hospital death because of persistent infection. Major postoperative complications occurred in 7 (70%) patients, with hypoxic encephalopathy occurring in 4 patients. Late prosthetic graft infection occurred in 1 patient, who died of massive gastrointestinal bleeding 4 months after the operation. Of the 9 patients with distal arch aneurysms, 3 were operated on through a sternotomy with a hospital mortality rate of 33% and an aneurysm-related mortality rate of 67%. The operation was performed through a thoracotomy in 6 patients, with no hospital mortality and an aneurysm- related mortality rate of 17%. Conclusions: Infected aortic arch aneurysm was uncommon and nontyphoid Salmonella was the most common pathogen. Current treatment with in situ graft replacement was associated with high mortality and morbidity . Improvements in cerebral protection and surgical techniques should improve patient outcome.
Subjects
ABDOMINAL-AORTA
MYCOTIC-ANEURYSM
SURGICAL-TREATMENT
ILIAC ARTERIES
THORACIC AORTA
SALMONELLA
Type
journal article