Mycotic aneurysms of the thoracic and abdominal aorta and iliac arteries: Experience with anatomic and extra-anatomic repair in 33 cases

Abstract

A mycotic aneurysm of the aortic iliac region remains a life-threatening condition, especially if the aneurysm has already ruptured by the time of surgery. Although the content of the aneurysm sac is considered septic, as was proved by positive cultures in 85% of our patients, in situ reconstruction is feasible and, surprisingly, was not more closely related to higher morbidity and mortality in our series than ligation and extra-anatomic reconstruction, although most of the aneurysms repaired in situ were located at the suprarenal and thoracoabdominal aorta. We assume that our operative mortality rate of 36%, which relates to a rupture rate of 85%, could be substantially lowered if the diagnosis of mycotic aneurysm were established before rupture.

Open Repair of Mycotic Abdominal Aortic Aneurysms With Biological Grafts: An International Multicenter Study

“…Infected tissue can be debrided and copious saline irrigation performed. Some centers prefer rifampicin‐soaked Dacron grafts, possibly providing extra protection against gram‐positive cocci 3, 14, 33, 34. Omental‐pedicle cover is as important as in biological reconstructions 3, 14, 20, 21, 22, 34.…”

Pseudoaneurysmal Formation in Abdominal Aorta Associated with Escherichia coli Infection

“…The prevalence of IAA in the abdominal aorta is 0.7-1.3% of all surgically treated aortic aneurysms (1)(2)(3)(4)(5). The mortality of IAA is high and depends upon the artery involved, treatments received, and underlying conditions.…”

“…The mortality of IAA is high and depends upon the artery involved, treatments received, and underlying conditions. Some reports of IAA demonstrated a perioperative mortality of 21-36% (3,6). Seven to 24% of IAA demonstrated free rupture and a further 47-61% demonstrate contained or impeding rupture at presentation and freely ruptured infected aneurysms have 63-100% mortality (3,6).…”

“…On the 5th day after admission (10th hospital day), the paDivision of Cardiovascular Medicine, Kanazawa University Graduate School of Medicine, Japan and Department of General and Cardiothoracic Surgery, Kanazawa University Graduate School of Medicine, Japan tient's lower back pain gradually worsened without significant physical findings. His white blood cell count was elevated to 12,700/mm 3 (Fig. 1), and hemoglobin value (Hb 8.4 g/dL) was decreased.…”

Kidney Salvage During Surgical Treatment of a Pararenal Mycotic Aortic Aneurysm

“…Symptoms are not typical, and vague abdominal or back pain may or may not accompany pyrexia whereas leukocytosis although almost uniformly present represents a non-specific finding [4]. Surgery is considered the mainstay of treatment, and in the presence of visceral involvement, most authors advocate routine in situ aortic revascularization [5,6]. Nevertheless, extra-anatomic reconstruction through uninfected tissue planes although technically challenging is feasible providing distal perfusion and preserving renal function in the presence of severe infection like in our case.…”