Mycotic Aneurysms-A Challenge and a Clue

Experience With Infected Aneurysms of the Abdominal Aorta

“…However, their patient re¬ turned after 19 months with an aortoduodenal fistula and subsequently required a second prosthetic graft before a third graft was placed through clean tissue planes rather than the original infected site.22 Instances where vascular reconstruction has been attempted in situ have almost al¬ ways resulted in recurrence or anastomotic leaks culmi¬ nating in death. [22][23][24][25] Many abdominal aneurysms are not recognized as in¬ fected prior to operation and these pose a particular prob¬ lem. All aneurysms should have their wall and intralumi¬ nal thrombus cultured and smeared, and if an infected aneurysm is suspected on the basis of the operative find¬ ings, the entire aneurysm should be resected.…”

Pseudomonas aeruginosa infected aneurysm of the superficial femoral artery

“…The femoral artery (as in the present case) has been described as the most frequent site of involvement, accounting for between 28 and 56% of cases reported. 2,4,5 The aorta (12-31%), mesenteric (2-8%) and intracranial (5-15%) arteries have also been commonly reported to be susceptible. 2,4,5 Since an intact intima is highly resistant to bacterial invasion, sites of intimal disruption are susceptible to infected aneurysm formation.…”

“…2,4,5 The aorta (12-31%), mesenteric (2-8%) and intracranial (5-15%) arteries have also been commonly reported to be susceptible. 2,4,5 Since an intact intima is highly resistant to bacterial invasion, sites of intimal disruption are susceptible to infected aneurysm formation. 6,7 For this reason, infected aneurysms are often seen at sites of significant atherosclerosis, arteriovenous fistulas, bifurcations and coarctations.…”

Infected Aortic Aneurysm

“…The first two types are sometimes referred to as secondary mycotic aneurysms, whereas the third is primary or cryptogenic (2, 4).…”

“…1) extension from a neighboring focus of purulent inflammation, 2) embolization from bacterial endocarditis, 3) dissemination of organisms in the blood stream, either from a known focus or from an unidentified port of entry, and 4) infection arising in a pre-existing aneurysm, usually by the mechanism described in #3. The first two types are sometimes referred to as secondary mycotic aneurysms, whereas the third is primary or cryptogenic (2,4).…”