Primary infected abdominal aortic aneurysm: Surgical procedures, early mortality rates, and a survey of the prevalence of infectious organisms over a 30-year period

Maeda, Hitoshi; Umezawa, Hisaki; Goshima, Masakazu; Hattori, Tsutomu; Nakamura, Tetsuya; Umeda, Tomofumi; Shiono, Motomi

doi:10.1007/s00595-010-4279-z

Cited by 65 publications

(52 citation statements)

References 33 publications

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“…Prevalence and etiology Mycotic aneurysms reflect fewer than 1% of aortic aneurysms that are surgically repaired, are more common in men, and are more likely to rupture than non-infected aneurysms (2)(3)(4)(5). Mycotic aneurysms are more likely to occur in the aorta than other arteries (6)(7)(8).…”

Section: Mycotic Aneurysmsmentioning

confidence: 99%

Inflammatory and infectious aortic diseases

Deipolyi

Czaplicki

Öklü

2018

Cardiovasc. Diagn. Ther.

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Aortitis is aortic inflammation, which can be due to inflammatory or infectious diseases. Left undiagnosed, aortitis can lead to aneurysm formation and rupture, in addition to ischemic compromise of major organs. Infectious aortic diseases include mycotic aneurysm and graft infection; the most common inflammatory diseases are Takayasu's and giant cell arteritis. We review the epidemiology, etiology, presentation and diagnosis, and treatment of these entities. S62infectious extravascular source adjacent the arterial wall (16,17). Bacteria may seed the arterial wall injury either from bacteremia or septic emboli (18). Typically, infection initiates in a nidus such as in an ulcerated atherosclerotic plaque or in the vasa vasorum (12). The vasa vasorum is thought to be key in the pathogenesis of MA formation; due to its small lumen size and slower flow, it is more susceptible to bacterial colonization (19,20). The vasa vasorum is more pronounced in larger arteries, which may explain why the aorta is the most common site of MA formation. DiagnosisEarly diagnosis and rapid triage for intervention is key to reducing mortality from MA (21,22). However, diagnosis is challenging given the low prevalence and nonspecific symptoms. Clinical signs may include fever and laboratory abnormalities including elevated erythrocyte sedimentation rate and leukocytosis (23). Bacteremia is common, though cultures may be negative, particularly after antibiotics have been given. Symptoms include pain or a pulsatile mass (23). In the setting of pre-existing endocarditis, prior invasive procedures, intravenous drug use or immunocompromise should increase suspicion (8,24).Non-invasive cross-sectional imaging is essential in the diagnosis of MA. Computed tomography angiography (CTA) has arisen as the imaging modality of choice owing to its excellent resolution allowing for three-dimensional reconstruction and its rapid acquisition; magnetic resonance imaging (MRI) may also be used (25)(26)(27). Certain features may distinguish MA from non-infected aneurysms, including serial imaging which may reveal rapid progression typical of infected aneurysms. Other characteristic features include contrast-enhancement and a saccular outpouching configuration, whereas non-infected atherosclerotic aneurysms tend to be fusiform (28). Saccular configuration may also suggest imminent rupture, alerting the need for further urgent diagnostic workup. Other features include irregularity of the arterial wall and peri-aortic gas, edema, mass or stranding (28). MAs also tend to have higher uptake on FDG-PET imaging of 4.5 SUV max or more compared with non-infected aneurysms (29). FDG-PET boasts high sensitivity and its potentially high false-positive rate can be improved with simultaneous CT. Treatment and prognosisDue to its elusive presentation, MA is often difficult to treat because of delayed diagnosis. Rapid diagnosis and treatment is key, as aortic MA is associated with 15-50% mortality (7)(8)(9)24). No randomized trials are available to guide manage...

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Section: Mycotic Aneurysmsmentioning

confidence: 99%

Inflammatory and infectious aortic diseases

Deipolyi

Czaplicki

Öklü

2018

Cardiovasc. Diagn. Ther.

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“…In addition, we used the rifampicinsoaked gelatin-sealed Dacron graft for axillo-bifemoral bypass. Recent studies show the satisfactory outcomes of in-situ reconstruction, [5][6][7][8] and this procedure also can be an effective surgical alternative for the treatment of primary infected abdominal aortic aneurysm. Rifampicinsoaked graft 5,6) or polytetrafluoroethylene graft 7) is an available conduit for the prevention of postoperative graft infection.…”

Section: Discussionmentioning

confidence: 98%

Two-stage Surgery for Double Infected Aneurysms in the Infrarenal Abdominal and Descending Thoracic Aorta

Nishigawa

Tabuchi

Takiuchi

et al. 2011

Annals of Vascular Diseases

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A 61-year-old man complaining of lumbago and high-grade fever was admitted to our institution. Computed tomography (CT) revealed a saccular aneurysm in the infrarenal abdominal aorta and blood culture results were positive for Streptococcus pneumoniae. He was diagnosed with infected abdominal aortic aneurysm, and antibiotic therapy was initiated. Follow-up CT demonstrated a rapidly-enlarging abdominal aortic aneurysm and a newly-developed descending thoracic aortic aneurysm. For this case, two-stage surgery consisting of extra-anatomical bypass and in-situ reconstruction using rifampicin-soaked Dacron graft was performed after an interval of 37 days. The patient was discharged 14 days after the second surgery without any complications.

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“…Some authorities recommend extending the incubation of blood cultures for up to 2 weeks to enable detection of slowly growing organisms (Francioli et al, 1985). Published studies show that when biopsy cultures from the aneurysm wall and blood cultures are done, at least one is positive in 66-100% of patients (Maeda et al, 2011).…”

Section: Discussionmentioning

confidence: 99%

“…Brossier et al (2012) described five cases in which they used IV antibiotics for 30 days followed by oral antibiotics for 52 weeks but did not mention the antibiotics used. Maeda et al (2011) reported three cases and used IV antibiotics for only 2-4 weeks until the WBC count and CRP were normal; all patients were alive at 1 year. Hagiya et al (2014) used IV ceftriaxone 2 gram daily and ciprofloxacin 300 mg Q12h for 36 days followed by long term oral ciprofloxacin but did not describe the dose and duration of ciprofloxacin in their patient.…”

Section: Discussionmentioning

confidence: 99%

<i>Campylobacter Fetus</i> Infection of the Aorta: A Case Report and Review of Literature

Ghimire¹,

Urban²,

Lee³

et al. 2015

American Journal of Infectious Diseases

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Campylobacter is a gram negative bacterium that exhibits tissue tropism. We report a case of Campylobacter fetus bacteremia associated with infra-renal abdominal aortitis. The patient was a poor surgical candidate so she was initially treated only medically. Her course was complicated by the development of a pseudoaneurysm. An endovascular stent was placed and the patient was given 4 more weeks of antibiotics. The patient continues to do well several months after stent placement. This case illustrates the success of medical treatment combined with stent placement in a patient who could not undergo surgery for an infected abdominal aortic pseudoaneurysm.

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Primary infected abdominal aortic aneurysm: Surgical procedures, early mortality rates, and a survey of the prevalence of infectious organisms over a 30-year period

Cited by 65 publications

References 33 publications

Inflammatory and infectious aortic diseases

Inflammatory and infectious aortic diseases

Two-stage Surgery for Double Infected Aneurysms in the Infrarenal Abdominal and Descending Thoracic Aorta

<i>Campylobacter Fetus</i> Infection of the Aorta: A Case Report and Review of Literature

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