Surgical Outcome for Mycotic Aortic and Iliac Anuerysm

Yu, Sheng-Yueh; Hsieh, Hung-Chang; Ko, Po-Jen; Huang, Yao-Kuang; Chu, Jaw-Ji; Lee, Chun-Hui
July 2011
World Journal of Surgery;Jul2011, Vol. 35 Issue 7, p1671
Academic Journal
Background: The present study was designed to review surgical outcomes for mycotic aneurysm of the aortic or iliac arteries at a single center. Methods: The study was based on retrospective chart review of patients undergoing operation for mycotic aneurysm. Results: From January 1998 to December 2007, 56 patients received surgical treatment for mycotic aneurysm of the aortic or iliac arteries. Aneurysm sites included the aortic arch ( n = 5), proximal thoracic aorta ( n = 4), distal thoracic aorta ( n = 5), paravisceral aorta ( n = 5), juxtarenal aorta ( n = 4), infrarenal aorta ( n = 30), and iliac arteries ( n = 3). Salmonella was the leading pathogen ( n = 34). Nineteen patients with suprarenal lesions underwent in situ prosthetic graft replacement ( n = 17), extra-anatomic bypass ( n = 1), or endovascular aneurysm repair (EVAR) ( n = 1), and 37 patients with infrarenal lesions underwent the same procedures ( n = 16, 20, and 1, respectively). Overall in-hospital mortality was 23%. After discharge, four patients (7%) developed reinfection that led to fatal sepsis. Graft infection developed after three in situ prosthetic grafts (9%) and one extra-anatomic bypass (5%). Patients with suprarenal aortic lesions had poorer in-hospital (34%) and late (16%) mortality rates than those with infrarenal lesions ( p = 0.025). Those with suprarenal lesions also had a lower cumulative survival rate ( p = 0.016). Conclusions: The location of mycotic aneurysm was the determinant of mortality. Mycotic aneurysm of the suprarenal aorta has poor prognosis and requires alternative surgical treatment.


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