Surgical Treatment for Primary Infected Aneurysm of the Descending Thoracic Aorta, Abdominal Aorta, and Iliac Arteries
Resource
JOURNAL OF VASCULAR SURGERY v.36 n.4 pp.746-750
Journal
JOURNAL OF
Journal Volume
VASCULAR
Journal Issue
n.4
Pages
746-750
Date Issued
2002
Date
2002
Author(s)
HSU, RON-BIN
Abstract
Objective and Method. In this retrospective review, we report the surgical results of infected aortic aneurysms treated at a single center over 5 years. Results. From October 1996 to October 2001, 19 patients with infected aortic aneurysm were treated with surgery, nine with suprarenal infections (four proximal descending thoracic aortic aneurysms, two distal descending thoracic aortic aneurysms, and three suprarenal abdominal aortic aneurysms) and 10 with infrarenal infections (eight infrarenal abdominal aortic aneurysms and two iliac artery aneurysms). All had a positive blood or tissue culture; 89% were febrile , 89% had leukocytosis, and 32% were hemodynamically unstable. The most common responsible pathogens were Salmonella organisms (74%) followed by Streptococcus species (11%). Nine of 10 infrarenal infections were caused by Salmonella organisms. Both infrarenal and suprarenal infections were treated with wide debridement of infected aorta, in situ prosthetic graft or patch repair, and prolonged intravenous antibiotics. Hospital survival rate was 95%: 100% for infrarenal and 89% for suprarenal infections. There was no perioperative intestinal ischemia or perioperative limb loss. Acute renal failure occurred in two patients with suprarenal infection. Late deaths have occurred in three patients with one early graft infection (5 %) resulting in the only one in-hospital death at 4 months. Sixteen patients remain alive at mean follow-up of 17.8 months (range, 4-47 months). There have been no late aortic or graft infections. During the same period, there were five unoperated patients, four of whom died of shock during hospitalization. Conclusions. Infected aortic aneurysm is common in Taiwan , and Salmonella species were the most common responsible microorganisms. With surgical intervention and prolonged intravenous antibiotics, in situ graft replacement provided a good outcome. The incidence of prosthetic graft infection was low, even in patients with infections due to Salmonella species and with in situ graft replacement.
Subjects
MYCOTIC-ANEURYSM
SALMONELLA
BACTEREMIA
NONTYPHI SALMONELLA EXPERIENCE
Type
journal article