Selective medical treatment of infected aneurysms of the aorta in high risk patients

Hsu, Ron‐Bin; Chang, Chung-I; Wu, I-Hui; Lin, Fang‐Yue

doi:10.1016/j.jvs.2008.08.004

Cited by 63 publications

(57 citation statements)

References 24 publications

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“…Yet non‐ Salmonella infections are known to be associated with higher aneurysm‐related complications and death after treatment 2, 3, 10, 36. In the current study, none of them was significantly associated with death or reinfections.…”

Section: Discussioncontrasting

confidence: 48%

“…Hsu et al reported a reinfection rate and total graft‐related mortality of 5% during 2‐year follow‐up 35. However, the number of patients was small, the vast majority had Salmonella infection, known as a predictive factor for superior outcome, and numerous patients were in good general condition receiving antimicrobial treatment preoperatively for 4 to 6 weeks 2, 10, 35…”

Section: Discussionmentioning

confidence: 99%

“…MAAs are a rare, but life‐threatening entity with rapid clinical course and devastating outcomes without surgical intervention 2. Even with adequate treatment, mortality remains as high as 18% to 43% 3, 4, 5, 6, 7…”

Section: Introductionmentioning

confidence: 99%

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

Heinola

Sörelius

Wyss

et al. 2018

JAHA

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BackgroundThe treatment of mycotic abdominal aortic aneurysm requires surgery and antimicrobial therapy. Since prosthetic reconstructions carry a considerable risk of reinfection, biological grafts are noteworthy alternatives. The current study evaluated the durability, infection resistance, and midterm outcome of biological grafts in treatment of mycotic abdominal aortic aneurysm.Methods and ResultsAll patients treated with biological graft in 6 countries between 2006 and 2016 were included. Primary outcome measures were 30‐ and 90‐day survival, treatment‐related mortality, and reinfection rate. Secondary outcome measures were overall mortality and graft patency. Fifty‐six patients (46 males) with median age of 69 years (range 35–85) were included. Sixteen patients were immunocompromised (29%), 24 (43%) had concomitant infection, and 12 (21%) presented with rupture. Bacterial culture was isolated from 43 (77%). In‐situ aortic reconstruction was performed using autologous femoral veins in 30 patients (54%), xenopericardial tube‐grafts in 12 (21%), cryopreserved arterial/venous allografts in 9 (16%), and fresh arterial allografts in 5 (9%) patients. During a median follow‐up of 26 months (range 3 weeks–172 months) there were no reinfections and only 3 patients (5%) required assistance with graft patency. Thirty‐day survival was 95% (n=53) and 90‐day survival was 91% (n=51). Treatment‐related mortality was 9% (n=5). Kaplan–Meier estimation of survival at 1 year was 83% (95% confidence interval, 73%–94%) and at 5 years was 71% (52%–89%).ConclusionsMycotic abdominal aortic aneurysm repair with biological grafts is a durable option for patients fit for surgery presenting an excellent infection resistance and good overall survival.

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Section: Discussioncontrasting

confidence: 48%

Section: Discussionmentioning

confidence: 99%

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

Heinola

Sörelius

Wyss

et al. 2018

JAHA

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“…With the high percentage of disease evolution to aneurysm rupture, antibiotic treatment alone results in extremely poor prognoses and should be only reserved for those with very high surgical risk and significant medical comorbidities [69]. Aggressive debridement with aortic reconstruction remains the gold-standard operative procedure; however, a complicated postoperative course generally could be anticipated [7].…”

Section: Managementmentioning

confidence: 99%

“…If an infected aortic aneurysm is suspected clinically, systemic broad-spectrum antibiotics should be initiated immediately before definite pathogen identification [69,75]. Because of the high prevalence of Salmonella species infection in our country, we prefer administering ceftriaxone in every case of an infected aortic aneurysm if there is no contraindication [12,69,71].…”

Section: Antibiotic Therapymentioning

confidence: 99%

Infected Aortic Aneurysms

Lin¹,

Kan²

2017

Aortic Aneurysm

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Infected aortic aneurysms are surgical urgencies, requiring prompt management to avoid the development of catastrophic complications. Although traditional open surgery composed of radical debridement and aortic reconstruction remains the gold-standard, many favorable results of the endovascular repair strategy have been reported. In this chapter, the etiology, bacteriology, clinical manifestation, and diagnostic criteria of infected aortic aneurysms will be discussed in detail at first, followed by a comprehensive review of both traditional open surgery and endovascular repair, based on current evidences and the authors' institutional experience. Along with long-term oral antibiotic suppression and aggressive adjunctive procedures, endovascular repair for uncomplicated infected aortic aneurysms could be a definite treatment alternative to traditional open surgery in the endovascular era.

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Open Repair of Abdominal Aortic Aneurysms

Brady

Chaikof

2012

Haimovici's Vascular Surgery

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Selective medical treatment of infected aneurysms of the aorta in high risk patients

Abstract: Clinical results of medical treatment using current antibiotics in patients with infected aortic aneurysm were poor. Traditional surgical excision of infected aortic aneurysms with revascularization remains the gold standard and should be attempted except in high risk patients.

Cited by 63 publications

References 24 publications

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

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

Infected Aortic Aneurysms

Open Repair of Abdominal Aortic Aneurysms

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