Scientific papers
Surgical treatment of infected aneurysms and pseudoaneurysms of the thoracic and abdominal aorta

https://doi.org/10.1016/j.amjsurg.2004.03.020Get rights and content

Abstract

Background

To review the outcome of infected aneurysms and pseudoaneurysms of the thoracic and abdominal aorta treated in a major teaching hospital.

Methods

Between December 1994 and January 2003, 13 infected aortic aneurysms and pseudoaneurysms (5 thoracic, 4 paravisceral, 4 infrarenal) in 10 consecutive patients were treated surgically. Aortic debridement with in situ reconstruction is our standard practice. Endovascular repair was offered to suitable patients with thoracic aortic involvement.

Results

There were six men and four women with a mean age of 63 years. The commonest pathogen was Salmonella species, accounting for 50% of the cases. Aortic debridement with in situ revascularization was performed for six patients with visceral reconstruction in four of them. One patient with aortic bifurcation involvement and gross purulent infection had ligation and debridement followed by right axillobifemoral bypass. Four infected thoracic aortic pseudoaneurysms in three other patients underwent endovascular repair. There was no hospital death, limb loss, renal failure, or intestinal ischemia. There were two late deaths from sepsis and pneumonia at 3 months and 77 months after operation. Eight patients were alive after a mean follow-up of 36 months and no late graft infection was evident.

Conclusions

Surgical treatment for infected aortic aneurysms with in situ reconstruction is associated with favorable outcome and good long-term result. Endovascular repair has a potential role.

Section snippets

Patients and methods

Between December 1994 to January 2003, 10 consecutive patients with infected aneurysms of the thoracic and abdominal aorta were treated in the Division of Vascular Surgery, Department of Surgery, Queen Mary Hospital. The demographic data and investigation results especially bacteriology, surgical outcome, and follow-up data were reviewed. Patients were included only when the aneurysm had the typical appearance of an infected aneurysm on imaging (Fig. 1, Fig. 2), together with a positive

Patient demographics and presentation

There were six men and four women with a mean age of 63 years (range, 37–87 years). Four patients had ischemic heart disease, whereas each of hypertension, diabetes mellitus, or chronic renal impairment was present in three patients. Most patients were febrile or had a recent history of fever (80%). Abdominal and/or back pain was common (70%). Only half of the patients had palpable aneurysms/pseudoaneurysms. The typical triad of an infected aortic aneurysm (fever, pain, and pulsatile mass) was

Discussion

Infected aortic aneurysms used to be a deadly disease with high mortality and morbidity. The signs and symptoms are often nonspecific; the typical triad of infected aortic aneurysm, fever, pain, and pulsatile mass, was only present in less than half of our patients. One of the reasons is the propensity of paravisceral and thoracic involvement in infected aortic aneurysms [6], [7] that makes it difficult for access by physical examination. In a review of the 25-year experience at the Mayo’s

References (26)

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