Surgical Treatment of Infected Aortoiliac Aneurysm

Abstract

Purpose:Infected aneurysms of the abdominal aorta or iliac artery (IAAA) are rare but fatal and difficult to treat. The purpose of this study was to review the clinical presentations and outcomes of IAAA and to establish a treatment strategy for optimal treatment of IAAA.Materials and Methods:Electronic medical records of 13 patients treated for IAAA at Seoul National University Hospital between March 2004 and December 2012 were retrospectively reviewed.Results:Mean age was 64.2 (median 70, range 20–79) years. Aneurysms were located in the infrarenal aorta (n=7), iliac arteries (n=5), and suprarenal aorta (n=1). Seven patients underwent excision and in situ interposition graft, 3 underwent extra-anatomical bypass, and 1 underwent endovascular repair. One patient with endovascular repair in an outside hospital refused resection, and only debridement was done, which revealed tuberculosis infection. One staphylococcal infection was caused by iliac stenting. Mycobacterium was the most common pathogen, followed by Klebsiella, Salmonella, and Staphylococcus. There were 3 in-hospital mortalities and the causes were sepsis in 2 and aneurysm rupture in 1. The 3 extra-anatomic bypasses were all patent after 5-year follow-up.Conclusion:IAAA develops from various causes and various organisms. IAAA cases with gross pus were treated with extra-anatomic bypass, which was durable. In situ reconstruction is favorable for long term-safety and efficacy, but extensive debridement is essential.

Tratamiento endovascular de aneurismas micóticos de la arteria ilíaca: revisión de la literatura y análisis de un caso de ruptura

“…La edad de presentación fue variable, ya que se presentó en pacientes tan jóvenes como de 20 años o en edades de hasta 83 años, y el género masculino fue el de mayor prevalencia. Los reportes de permeabilidad de stents recubiertos usualmente se encuentran por encima del 95% al año [15][16][17][18] . Usualmente, el tratamiento incluye, además de la exclusión endovascular del AM, antibioticoterapia específica para el microorganismo aislado por tiempo prolongado y, en caso de aparición de abscesos intraabdominales, se recomienda su drenaje, el cual puede realizarse vía percutánea 7 .…”

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

“…Among 3 in-hospital deaths, there was 1 case of tuberculosis, which we found to be resistant to antibiotics. 4 ) MRSA is resistant to the rifampicin-soaked graft and generally considered to be one of the prognostic factors in patients with MAA. However, all 3 patients with MRSA in our series did not have infection-related events.…”

“…Previous reports have suggested that extra-anatomic reconstruction should be performed in patients with gross pus or remnant inflammation, whereas in situ reconstruction is recommended for patients who respond well to antibiotics. 4 )…”

Infected Iliac Artery Aneurysm Concomitant with Liver Abscess Caused by <i>Fusobacterium nucleatum</i>

“…is rare [14]- [16]. Several cases of IAA associated with liver abscess have been reported, but they were not caused by Fusobacterium [17] [18]. Therefore, IAA concomitant with liver abscess caused by Fusobacterium is extremely rare.…”