Surgical Outcome for Mycotic Aortic and Iliac Anuerysm

• DOI: 10.1007/s00268-011-1104-9
• Publication Date: 2011-05-03T15:52:56Z
• Authors: Sheng‐Yueh Yu; Hung‐Chang Hsieh; Po‐Jen Ko; Yao‐Kuang Huang; Jaw‐Ji Chu; Chun‐Hui Lee
• Keywords: Adult; Aged, 80 and over; Male; Middle Aged; Aneurysm; Iliac Artery; 3. Good health; 03 medical and health sciences; Treatment Outcome; 0302 clinical medicine; Humans; Female; Aneurysm, Infected; Aged; Aortic Aneurysm, Abdominal; Retrospective Studies

AbstractBackgroundThe present study was designed to review surgical outcomes for mycotic aneurysm of the aortic or iliac arteries at a single center.MethodsThe study was based on retrospective chart review of patients undergoing operation for mycotic aneurysm.ResultsFrom January 1998 to December 2007, 56 patients received surgical treatment for mycotic aneurysm of the aortic or iliac arteries. Aneurysm sites included the aortic arch (n = 5), proximal thoracic aorta (n = 4), distal thoracic aorta (n = 5), paravisceral aorta (n = 5), juxtarenal aorta (n = 4), infrarenal aorta (n = 30), and iliac arteries (n = 3). Salmonella was the leading pathogen (n = 34). Nineteen patients with suprarenal lesions underwent in situ prosthetic graft replacement (n = 17), extra‐anatomic bypass (n = 1), or endovascular aneurysm repair (EVAR) (n = 1), and 37 patients with infrarenal lesions underwent the same procedures (n = 16, 20, and 1, respectively). Overall in‐hospital mortality was 23%. After discharge, four patients (7%) developed reinfection that led to fatal sepsis. Graft infection developed after three in situ prosthetic grafts (9%) and one extra‐anatomic bypass (5%). Patients with suprarenal aortic lesions had poorer in‐hospital (34%) and late (16%) mortality rates than those with infrarenal lesions (p = 0.025). Those with suprarenal lesions also had a lower cumulative survival rate (p = 0.016).ConclusionsThe location of mycotic aneurysm was the determinant of mortality. Mycotic aneurysm of the suprarenal aorta has poor prognosis and requires alternative surgical treatment.