In Situ Reconstruction with Extended Debridement in Patients with Mycotic Abdominal Aortic Aneurysms

Abstract

The surgical outcomes in patients with mycotic aortic aneurysm are still poor. In situ reconstruction and extra-anatomical bypass are the 2 main surgical options used in these patients, both of which have postoperative complications: recurrence of infection and aortic stump blowout, respectively. We performed in situ reconstruction in 25 consecutive patients with mycotic abdominal aortic aneurysms together with extended debridement using an irrigation device, omental flap coverage, rifampicin-soaked prosthetic graft, and sufficient antibiotics administration. There were 3 in-hospital mortalities; however, no infection- or procedure-related adverse events were observed in other cases during the mid-term follow-up period.

Systematic Review of the Management of Mycotic Aortic Aneurysms

“…33 The Swedish survival figures for EVAR have been re-iterated in recent smaller studies. 10,27 Survival after OSR is superior to the Swedish data in some reports, 29,40 and in some not. 23 However, the quality of all these studies is poor, and there is no reliable comparison made between EVAR and OSR.…”

“…5,29,37 Additional use of systematic irrigation of the abdomen has been reported by Nemoto et al with promising results. 40 Reports on endovascular repair have mostly consisted of standard EVAR treatment. They have, however, also included cases of fenestrated and branched repair of suprarenal and thoraco-abdominal aneurysms, as well as hybrid repair with supra-aortic or visceral artery deviation followed by endovascular repair.…”

“…21,22,25,33 Nemoto et al reported no cases of IRCs when combining in situ reconstruction with extensive debridement, rifampicin soaked grafts, omental coverage, and additional use of routine irrigation with a so called Pulsavac. 40 Kan et al investigated MAAs complicated by aorto-oesophageal or aortobronchial fistulation in 29 patients treated between 1993 and 2014. 41 Those patients treated by an endovascular approach demonstrated an estimated 30 day survival of 93% vs. 57% for OSR (p ¼ .035).…”

Azygos Vein Aneurysm with Thrombosis and Aspergillus fumigatus Diagnosed Using Bronchoscopy: Case Report

“…To date, there are no guidelines or reviews on the optimal treatment strategy for AVA, but interventional or surgical treatment should strongly be considered in cases with clinical symptoms such as pulmonary embolism or pulmonary arterial hypertension, thrombus formation within the AVA in patients with oral anticoagulation, or patients with a contraindication to oral anticoagulants [ 14 ].…”

“…Surgical excision of the aneurysm-debridation of infected tissue or replacement with graft is standard of care [ 14 ]. However, this was not possible because of the patient’s age and hemo-dynamic conditions.…”