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Ogino H, Iida O, Akutsu K, Chiba Y, Hayashi H, Ishibashi-Ueda H, Kaji S, Kato M, Komori K, Matsuda H, Minatoya K, Morisaki H, Ohki T, Saiki Y, Shigematsu K, Shiiya N, Shimizu H, Azuma N, Higami H, Ichihashi S, Iwahashi T, Kamiya K, Katsumata T, Kawaharada N, Kinoshita Y, Matsumoto T, Miyamoto S, Morisaki T, Morota T, Nanto K, Nishibe T, Okada K, Orihashi K, Tazaki J, Toma M, Tsukube T, Uchida K, Ueda T, Usui A, Yamanaka K, Yamauchi H, Yoshioka K, Kimura T, Miyata T, Okita Y, Ono M, Ueda Y. JCS/JSCVS/JATS/JSVS 2020 Guideline on Diagnosis and Treatment of Aortic Aneurysm and Aortic Dissection. Circ J 2023; 87:1410-1621. [PMID: 37661428 DOI: 10.1253/circj.cj-22-0794] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/05/2023]
Affiliation(s)
- Hitoshi Ogino
- Department of Cardiovascular Surgery, Tokyo Medical University
| | - Osamu Iida
- Cardiovascular Center, Kansai Rosai Hospital
| | - Koichi Akutsu
- Cardiovascular Medicine, Nippon Medical School Hospital
| | - Yoshiro Chiba
- Department of Cardiology, Mito Saiseikai General Hospital
| | | | | | - Shuichiro Kaji
- Department of Cardiovascular Medicine, Kansai Electric Power Hospital
| | - Masaaki Kato
- Department of Cardiovascular Surgery, Morinomiya Hospital
| | - Kimihiro Komori
- Division of Vascular and Endovascular Surgery, Department of Surgery, Nagoya University Graduate School of Medicine
| | - Hitoshi Matsuda
- Department of Cardiovascular Surgery, National Cerebral and Cardiovascular Center
| | - Kenji Minatoya
- Department of Cardiovascular Surgery, Graduate School of Medicine, Kyoto University
| | | | - Takao Ohki
- Division of Vascular Surgery, Department of Surgery, The Jikei University School of Medicine
| | - Yoshikatsu Saiki
- Division of Cardiovascular Surgery, Graduate School of Medicine, Tohoku University
| | - Kunihiro Shigematsu
- Department of Vascular Surgery, International University of Health and Welfare Mita Hospital
| | - Norihiko Shiiya
- First Department of Surgery, Hamamatsu University School of Medicine
| | | | - Nobuyoshi Azuma
- Department of Vascular Surgery, Asahikawa Medical University
| | - Hirooki Higami
- Department of Cardiology, Japanese Red Cross Otsu Hospital
| | | | - Toru Iwahashi
- Department of Cardiovascular Surgery, Tokyo Medical University
| | - Kentaro Kamiya
- Department of Cardiovascular Surgery, Tokyo Medical University
| | - Takahiro Katsumata
- Department of Thoracic and Cardiovascular Surgery, Osaka Medical College
| | - Nobuyoshi Kawaharada
- Department of Cardiovascular Surgery, Sapporo Medical University School of Medicine
| | | | - Takuya Matsumoto
- Department of Vascular Surgery, International University of Health and Welfare
| | | | - Takayuki Morisaki
- Department of General Medicine, IMSUT Hospital, the Institute of Medical Science, the University of Tokyo
| | - Tetsuro Morota
- Department of Cardiovascular Surgery, Nippon Medical School Hospital
| | | | - Toshiya Nishibe
- Department of Cardiovascular Surgery, Tokyo Medical University
| | - Kenji Okada
- Department of Surgery, Division of Cardiovascular Surgery, Kobe University Graduate School of Medicine
| | | | - Junichi Tazaki
- Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University
| | - Masanao Toma
- Department of Cardiology, Hyogo Prefectural Amagasaki General Medical Center
| | - Takuro Tsukube
- Department of Cardiovascular Surgery, Japanese Red Cross Kobe Hospital
| | - Keiji Uchida
- Cardiovascular Center, Yokohama City University Medical Center
| | - Tatsuo Ueda
- Department of Radiology, Nippon Medical School
| | - Akihiko Usui
- Department of Cardiac Surgery, Nagoya University Graduate School of Medicine
| | - Kazuo Yamanaka
- Cardiovascular Center, Nara Prefecture General Medical Center
| | - Haruo Yamauchi
- Department of Cardiac Surgery, The University of Tokyo Hospital
| | | | - Takeshi Kimura
- Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University
| | | | - Yutaka Okita
- Department of Surgery, Division of Cardiovascular Surgery, Kobe University Graduate School of Medicine
| | - Minoru Ono
- Department of Cardiac Surgery, Graduate School of Medicine, The University of Tokyo
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Gunawardena T, Godakandage M, Abeywickrama S, Cassim R, Wijeyaratne M. Mycotic aortic aneurysm in a debilitated patient with compromised immunity; beware of Candida! J Vasc Bras 2021; 20:e20210122. [PMID: 34925475 PMCID: PMC8668086 DOI: 10.1590/1677-5449.210122] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Accepted: 09/01/2021] [Indexed: 11/21/2022] Open
Abstract
Candida is a rare cause of infected aortic aneurysms. We report the case of a diabetic patient with end stage kidney disease who underwent repair of a leaking abdominal aortic aneurysm. He was on long-term antibiotic treatment for malignant otitis externa. Candida albicans was isolated from the culture of the excised aneurysm wall. An infected aortic aneurysm due to Candida has not been previously reported in a patient with malignant otitis externa. This case report aims to highlight that Candida should be suspected as a cause of infected aortic aneurysms in patients with debilitation and chronic immunosuppression. Management of such cases can be extremely challenging, especially in resource-poor settings, and we will be touching upon the advantages and disadvantages of various treatment options.
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Affiliation(s)
- Thilina Gunawardena
- The Royal Liverpool University Hospital, Liverpool, the United Kingdom.,National Hospital of Sri Lanka, Colombo, Sri Lanka
| | | | - Sachith Abeywickrama
- The Royal Liverpool University Hospital, Liverpool, the United Kingdom.,Worcestershire Acute Care Hospitals, the United Kingdom
| | - Rezni Cassim
- The Royal Liverpool University Hospital, Liverpool, the United Kingdom
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3
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Touma J, Couture T, Davaine JM, de Boissieu P, Oubaya N, Michel C, Cochennec F, Chiche L, Desgranges P. Mycotic/Infective Native Aortic Aneurysms: Results After Preferential Use of Open Surgery and Arterial Allografts. Eur J Vasc Endovasc Surg 2021; 63:475-483. [PMID: 34872811 DOI: 10.1016/j.ejvs.2021.10.041] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Revised: 09/20/2021] [Accepted: 10/09/2021] [Indexed: 11/03/2022]
Abstract
OBJECTIVE Mycotic/infective native aortic aneurysms (INAA) are managed heterogeneously. In the context of disparate literature, this study aimed to assess the outcomes of INAA surgical management and provide comprehensive data in alignment with recent suggestions for reporting standards. METHODS A retrospective review of patients presenting with INAA from September 2002 to March 2020 at two institutions was conducted. In hospital mortality, 90 day mortality, overall mortality, and infection related complications (IRCs) were the study endpoints. Overall survival and IRC free survival were estimated, and predictors of mortality tested using uni- and multivariable analyses. RESULTS Seventy patients (60 men [86%], median age 68 years [range 59 - 76 years]) were included. Twenty (29%) were ruptured at presentation. INAA location was thoracic in 11 (16%) cases, thoraco-abdominal in seven (10%), and abdominal in 50 (71%). Half of the abdominal INAAs were suprarenal. Two INAAs were concomitantly abdominal and thoracic. Pathogens were identified in 83%. The bacterial spectrum was scattered, with rare Salmonella species (n = 6; 9%). Open surgical repair was performed in 66 (94%) patients, including five conversions of initially attempted endovascular grafts (EVAR), three hybrid procedures, and one palliative EVAR. Vascular substitutes were cryopreserved arterial allografts (n = 67; 96%), prosthesis (n = 2), or femoral veins (n = 1). Kaplan-Meier estimates of overall survival at 30 and 90 days were 87% (95% confidence interval [CI] 76.6 - 93.0) and 71.7% (95% CI 59.2 - 80.9), respectively. The overall in hospital mortality rate was 27.9% (95% CI 1.8 - 66.5). IRCs occurred in seven (10%) patients. The median follow up period was 26.5 months (range 13.0-66.0 months). Chronic kidney disease (CKD) was independently related to in hospital mortality (odds ratio [OR] 20.7, 95% CI 1.8 - 232.7). American Society of Anesthesiologists score of 3 (OR 6.0, 95% CI 1.1 - 33.9), 4 (OR 14.9, 95% CI 1.7 - 129.3), and CKD (OR 32.0, 95% CI 1.2 - 821.5) were related to 90 day mortality. CONCLUSION Surgical INAA management has significant mortality and a low re-infection rate. EVAR necessitated secondary open repair, but its limited use in this report did not allow conclusions to be drawn.
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Affiliation(s)
- Joseph Touma
- AP-HP, Henri Mondor University Hospital, Vascular surgery department, Creteil, France; Univ Paris Est Creteil, INSERM, IMRB, Creteil, France.
| | - Thibault Couture
- AP-HP, La Pitié-Salpêtrière University Hospital, Vascular Surgery Department, Paris, France
| | - Jean-Michel Davaine
- AP-HP, La Pitié-Salpêtrière University Hospital, Vascular Surgery Department, Paris, France; Sorbonnes Universités UPMC Univ Paris 06, UMRS 1138, Centre de recherche des Cordeliers, Paris, France
| | - Paul de Boissieu
- AP-HP, Bicêtre University Hospital, Epidemiology and Public Health department, Le Kremlin Bicêtre, France
| | - Nadia Oubaya
- Univ Paris Est Creteil, INSERM, IMRB, Creteil, France; AP-HP, Henri Mondor University Hospital, Department of Public Health, Creteil, France
| | - Cassandre Michel
- AP-HP, Henri Mondor University Hospital, Vascular surgery department, Creteil, France
| | - Frédéric Cochennec
- AP-HP, Henri Mondor University Hospital, Vascular surgery department, Creteil, France
| | - Laurent Chiche
- AP-HP, La Pitié-Salpêtrière University Hospital, Vascular Surgery Department, Paris, France
| | - Pascal Desgranges
- AP-HP, Henri Mondor University Hospital, Vascular surgery department, Creteil, France
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Hashimoto M, Mogi K, Sakurai M, Sakata T, Tani K, Takahara Y. Rupture of a dissecting thoracoabdominal aortic aneurysm due to Citrobacter freundii infection. Clin Case Rep 2021; 9:e04719. [PMID: 34484758 PMCID: PMC8405421 DOI: 10.1002/ccr3.4719] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Revised: 05/11/2021] [Accepted: 07/26/2021] [Indexed: 11/12/2022] Open
Abstract
We describe a case of an elderly man with Citrobacter freundii-associated infectious rupture of a dissecting thoracoabdominal aortic aneurysm. We performed an emergency thoracoabdominal aortic replacement using a rifampicin-soaked prosthetic graft and omental flap wrapping. The patient was discharged on postoperative day 255, although he experienced pseudomembranous enteritis and paraplegia.
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Affiliation(s)
- Masafumi Hashimoto
- Division of Cardiovascular SurgeryFunabashi Municipal Medical Center Heart and Vascular InstituteFunabashiJapan
| | - Kenji Mogi
- Division of Cardiovascular SurgeryFunabashi Municipal Medical Center Heart and Vascular InstituteFunabashiJapan
| | - Manabu Sakurai
- Division of Cardiovascular SurgeryFunabashi Municipal Medical Center Heart and Vascular InstituteFunabashiJapan
| | - Tomoki Sakata
- Division of Cardiovascular SurgeryFunabashi Municipal Medical Center Heart and Vascular InstituteFunabashiJapan
| | - Kengo Tani
- Division of Cardiovascular SurgeryFunabashi Municipal Medical Center Heart and Vascular InstituteFunabashiJapan
| | - Yoshiharu Takahara
- Division of Cardiovascular SurgeryFunabashi Municipal Medical Center Heart and Vascular InstituteFunabashiJapan
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Rustum S, Beckmann E, Martens A, Krüger H, Arar M, Kaufeld T, Haverich A, Shrestha ML. Native and prosthetic graft infections of the thoracic aorta: surgical management. Eur J Cardiothorac Surg 2021; 60:633-641. [PMID: 33783489 DOI: 10.1093/ejcts/ezab143] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Revised: 12/22/2020] [Accepted: 01/13/2021] [Indexed: 01/16/2023] Open
Abstract
OBJECTIVES Infection of the native aorta or after previous open or endovascular repair of the thoracic aorta is associated with high risks for morbidity and mortality. We analysed the outcome after surgical management of a native mycotic aneurysm or of prosthetic graft infection of the descending aorta. METHODS From June 2000 to May 2019, a total of 39 patients underwent surgery in our centre for infection of the native descending aorta (n = 19 [49%], group A) or a prosthetic descending aorta [n = 20 (51%), group B]. In the 20 patients in group B, a total of 8 patients had prior open aortic repair with a prosthesis and 12 patients had a previous endovascular graft repair. RESULTS The cohort patients had a mean age of 57 ± 14; 62% were men (n = 24). The most common symptoms at the time of presentation included fever, thoracic or abdominal pain and active bleeding. Emergency surgery was performed in 11 patients (28%); 3 patients had emergency endovascular stent grafts implanted during thoracic endovascular aortic repair for aortic rupture before further open repair. The 30-day mortality was 42% in group A and 35% in group B. The 90-day mortality was 47% in group A and 45% in group B. Pathogens could be identified in approximately half of the patients (46%). The most commonly identified pathogens were Staphylococcus aureus in 6 patients (15%) and Staphylococcus epidermidis in 4 patients (10%). Survival of the entire group (including patients with both native and prosthetic graft infections) was 44 ± 8%, 39 ± 8% and 39 ± 8% at 1, 2 and 3 years after surgery. The percentage of patients who survived the initial perioperative period was 81 ± 9%, 71 ± 9% and 71 ± 10% at 1, 2 and 3 years after surgery. CONCLUSIONS Patients with infection of the descending aorta, either native or prosthetic, are associated with both high morbidity and mortality. However, patients who survive the initial perioperative period have an acceptable long-term prognosis. In emergency situations, thoracic endovascular aortic repair may help to stabilize patients and serve as bridge to open repair.
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Affiliation(s)
- Saad Rustum
- Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Erik Beckmann
- Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Andreas Martens
- Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Heike Krüger
- Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Morsi Arar
- Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Tim Kaufeld
- Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Axel Haverich
- Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Malakh Lal Shrestha
- Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
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Premnath S, Zaver V, Hostalery A, Rowlands T, Quarmby J, Singh S. Mycotic Abdominal Aortic Aneurysms - A Tertiary Centre Experience and Formulation of a Management Protocol. Ann Vasc Surg 2021; 74:246-257. [PMID: 33508457 DOI: 10.1016/j.avsg.2020.12.025] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Revised: 12/07/2020] [Accepted: 12/16/2020] [Indexed: 01/16/2023]
Abstract
BACKGROUND Mycotic abdominal aorta aneurysm (MAAA) is a rare and life-threatening condition. Because of its rarity, there is a lack of adequately powered studies and consensus on its treatment and follow up. This study aimed to review the outcomes following surgical intervention for MAAA in a single tertiary centre and to formulate a management protocol based on available evidence and expert opinion. MATERIALS AND METHODS Data were collected by retrospective review of case records of all patients who underwent repair of MAAA in a single tertiary referral centre from 2001 to 2018. Demographic, clinical and outcome data were analysed and compared with previously published series in the literature. A management protocol was formulated based on available literature which was then reviewed and modified as per expert opinion from multidisciplinary discussions. RESULTS Seventeen patients underwent repair of MAAA during the study period including 4 Open repairs, 4 surgeon modified fenestrated endovascular aortic aneurysm repairs (SM FEVAR) and 9 endovascular aortic aneurysm repairs (EVAR). One-year overall survival was 94.1%, 3-year survival was 81.8% and 5-year survival was 75.0%. The infection-free survival at 1, 3, and 5 years was 87.5%, 81.8% and 62.5%, respectively. The overall survival and infection-free survival curves for Open repair, EVAR and SM FEVAR when compared using Log Rank (Mantel-Cox) test and did not show any statistically significant difference. CONCLUSIONS Management of MAAA with selective use of open or endovascular repair, in combination with appropriate long-term antibiotic therapy, can achieve acceptable outcomes. The proposed protocol can aid as a guiding document for the management of MAAA but needs taking into consideration individual patient variability and local expertise.
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Affiliation(s)
- Sivaram Premnath
- Department of Vascular Surgery, University Hospitals of Derby & Burton NHS Foundation Trust, Derby, UK.
| | - Vasudev Zaver
- Department of Vascular Surgery, University Hospitals of Derby & Burton NHS Foundation Trust, Derby, UK
| | - Aurelien Hostalery
- Department of Vascular Surgery, University Hospitals of Derby & Burton NHS Foundation Trust, Derby, UK
| | - Timothy Rowlands
- Department of Vascular Surgery, University Hospitals of Derby & Burton NHS Foundation Trust, Derby, UK
| | - John Quarmby
- Department of Vascular Surgery, University Hospitals of Derby & Burton NHS Foundation Trust, Derby, UK
| | - Sanjay Singh
- Department of Vascular Surgery, University Hospitals of Derby & Burton NHS Foundation Trust, Derby, UK
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Takahara Y, Nishiki K, Nakase K, Mizuno S. Ruptured pseudoaneurysm of the thoracic aorta mimicking lung cancer: A case report. Thorac Cancer 2021; 12:685-689. [PMID: 33421335 PMCID: PMC7919164 DOI: 10.1111/1759-7714.13783] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Revised: 11/27/2020] [Accepted: 11/27/2020] [Indexed: 11/29/2022] Open
Abstract
A 70‐year‐old woman was admitted to a local hospital with a five‐day history of back pain. She had been referred to our hospital after an abnormal chest shadow was identified on chest X‐ray. Chest computed tomography (CT) revealed an anterior mediastinal mass in the upper lobe of the left lung. Her general condition was good. She was diagnosed with lung cancer, and examination was planned. However, respiratory failure rapidly worsened on hospital day 2, and a ruptured pseudoaneurysm of the thoracic aorta (PTA) was diagnosed from contrast‐enhanced CT. Emergency thoracic endovascular aortic repair was successfully performed, and her postoperative course was uneventful. The hemodynamics of the PTA were stable in the case of this patient, but the risk of rupture is extremely high and frequently fatal. PTA should therefore be included among the differential diagnoses of mediastinal tumor. Key points Significant findings of the study Pseudoaneurysm of the thoracic aorta (PTA) may present on imaging findings that resemble lung cancer. What this study adds PTA should be included among the differential diagnoses of mediastinal tumor. Clinicians therefore need to be familiar with the imaging findings of PTA.
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Affiliation(s)
- Yutaka Takahara
- Department of Respiratory Medicine, Kanazawa Medical University, Kahoku-gun, Japan
| | - Kazuaki Nishiki
- Department of Respiratory Medicine, Kanazawa Medical University, Kahoku-gun, Japan
| | - Keisuke Nakase
- Department of Respiratory Medicine, Kanazawa Medical University, Kahoku-gun, Japan
| | - Shiro Mizuno
- Department of Respiratory Medicine, Kanazawa Medical University, Kahoku-gun, Japan
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Multidisciplinary Management of an Aorto-esophageal Injury Caused by Foreign Body Ingestion. Ann Vasc Surg 2020; 72:668.e1-668.e4. [PMID: 33333195 DOI: 10.1016/j.avsg.2020.10.039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Revised: 10/21/2020] [Accepted: 10/27/2020] [Indexed: 11/23/2022]
Abstract
A 37-year-old incarcerated male ingested a complex "X-shaped" foreign body that resulted in a penetrating aorto-esophageal injury. A primary esophagotomy with retrieval of the foreign body and muscle flap closure was performed simultaneously with thoracic endovascular aortic repair. This multidisciplinary surgical approach controls for both immediate exsanguination and postoperative complications to improve patient outcome.
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Okugi S, Azuma T, Yokoi Y, Domoto S, Niinami H. Therapeutic Strategies for Infectious Multiple Aortic Aneurysms: Thoracoabdominal Aortic Aneurysm Treatment Using a Fenestrated Stent-Graft. Ann Vasc Dis 2020; 13:326-329. [PMID: 33384740 PMCID: PMC7751079 DOI: 10.3400/avd.cr.20-00032] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Recently, it has been reported that a fenestrated stent graft is an effective option in the treatment of pararenal artery abdominal aortic aneurysm. We report the case of a 72-year-old male patient with multiple aortic aneurysms in the distal arch, thoracoabdominal aorta, right common iliac artery, as well as a pararenal abdominal aortic aneurysm. The patient was found to have a mass with a tendency of rapid expansion within a month from its discovery. Because it was a saccular aneurysm with a tendency of rapid expansion and wide spread, the risk of rupture was judged to be high, and surgical treatment became necessary. One-stage treatment was desirable; therefore, endovascular treatment with a fenestrated stent graft was selected. Four fenestrations were made to a stent graft for the celiac artery, superior mesenteric artery, and bilateral renal arteries. The postoperative computed tomography (CT) showed no branch occlusion or endoleak, and the 2-year postoperative CT showed the shrinkage and subsequent disappearance of the aortic aneurysm at the treatment site. For extensive aortic aneurysm, including pararenal artery abdominal aortic aneurysms, one-stage treatment with fenestrated stent graft was considered to be effective as a treatment strategy. (This is a translation of Jpn J Vasc Surg 2020; 29: 9–13.)
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Affiliation(s)
- Satoshi Okugi
- Department of Cardiovascular Surgery, The Tokyo Women's Medical University
| | - Takashi Azuma
- Department of Cardiovascular Surgery, The Tokyo Women's Medical University
| | - Yoshihiko Yokoi
- Department of Cardiovascular Surgery, The Tokyo Women's Medical University
| | - Satoru Domoto
- Department of Cardiovascular Surgery, The Tokyo Women's Medical University
| | - Hiroshi Niinami
- Department of Cardiovascular Surgery, The Tokyo Women's Medical University
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Sörelius K, Budtz-Lilly J, Mani K, Wanhainen A. Systematic Review of the Management of Mycotic Aortic Aneurysms. Eur J Vasc Endovasc Surg 2019; 58:426-435. [DOI: 10.1016/j.ejvs.2019.05.004] [Citation(s) in RCA: 52] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2018] [Revised: 04/24/2019] [Accepted: 05/01/2019] [Indexed: 12/21/2022]
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Sörelius K, di Summa PG. On the Diagnosis of Mycotic Aortic Aneurysms. CLINICAL MEDICINE INSIGHTS-CARDIOLOGY 2018; 12:1179546818759678. [PMID: 29497343 PMCID: PMC5824903 DOI: 10.1177/1179546818759678] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2017] [Accepted: 01/25/2018] [Indexed: 12/13/2022]
Abstract
Objective: There is striking paucity in consensus on the terminology, definition, and diagnostic criteria of mycotic aortic aneurysms. This literature study aims to elucidate this scientific omission, discuss its consequences, and present a proposition for reporting items on this disease. Methods: A systematic literature review on PubMed and Medline using mycotic and infected aortic aneurysms between 1850 and 2017 was performed. Articles were assessed according to a protocol regarding terminology, definition, and diagnostic criteria. Case series with less than 5 patients were excluded. Results: A total of 49 articles were included. The most prevalent term was mycotic aortic aneurysm but there was no widely accepted definition. Most modern publications used a diagnostic workup based on a combination on clinical presentation, laboratory results, imaging findings, and intraoperative findings. How these protean variables should be balanced was unclear. A proposition of reporting items was framed and consisted of definition of disease used, basis of diagnostic workup, exclusion criteria, patient characteristics, laboratory and imaging findings, aneurysm anatomy, details on treatment, pre/postoperative antibiotic treatment, and details on follow-up. Conclusions: This article emphasizes the need to standardize definition, terminology, and diagnostic criteria for mycotic aortic aneurysms and proposes reporting items enhancing comparability between studies.
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Affiliation(s)
- Karl Sörelius
- Department of Surgical Sciences, Section of Vascular Surgery, Uppsala University, Uppsala, Sweden
| | - Pietro G di Summa
- Department of Plastic, Reconstructive, and Hand Surgery, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
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Wong OF, Lam TSK, Wong TT, Fung HT. An Uncommon Cause of Deep Vein Thrombosis: Mycotic Aneurysm Secondary to Salmonella Arteritis. HONG KONG J EMERG ME 2017. [DOI: 10.1177/102490790901600411] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Mycotic aneurysm is an uncommon surgical emergency with high mortality. Endovascular infection due to salmonella is the commonest cause of intra-abdominal mycotic aneurysm. We report a rare presentation of mycotic aneurysm in a 78-year-old man who presented to the accident and emergency department with deep vein thrombosis due to compression of the iliac vein by a mycotic aneurysm arising from the internal iliac artery and an adjacent abscess. A comprehensive review of the aetiology, clinical presentation and management of mycotic aneurysm secondary to salmonella arteritis is presented.
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Anibueze C, Sankaran V, Sadat U, Tan K, Wilson YG, Brightwell RE, Delbridge MS, Stather PW. Neoaortic Xenoprosthetic Grafts for Treatment of Mycotic Aneurysms and Infected Aortic Grafts. Ann Vasc Surg 2017. [DOI: 10.1016/j.avsg.2017.02.021] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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15
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Ito F, Inokuchi R, Matsumoto A, Kumada Y, Yokoyama H, Ishida T, Hashimoto K, Narita M, Shinohara K. Presence of periaortic gas in Clostridium septicum-infected aortic aneurysm aids in early diagnosis: a case report and systematic review of the literature. J Med Case Rep 2017; 11:268. [PMID: 28931420 PMCID: PMC5607595 DOI: 10.1186/s13256-017-1422-0] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2017] [Accepted: 08/08/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Clostridium septicum-infected aortic aneurysm is a fatal and rare disease. We present a fatal case of C. septicum-infected aortic aneurysm and a pertinent literature review with treatment suggestions for reducing mortality rates. CASE PRESENTATION A 58-year-old Japanese man with an unremarkable medical history presented with a 3-day history of mild weakness in both legs, and experienced paraplegia and paresthesia a day before admission. Upon recognition of signs of an abdominal aortic aneurysm and paraplegia, we suspected an occluded Adamkiewicz artery and performed a contrast-enhanced computed tomography scan, which revealed an aortic aneurysm with periaortic gas extending from his chest to his abdomen and both kidneys. Antibiotics were initiated followed by emergency surgery for source control of the infection. However, owing to his poor condition and septic shock, aortic repair was not possible. We performed bilateral nephrectomy as a possible source control, after which we initiated mechanical ventilation, continuous hemodialysis, and hemoperfusion. A culture of the samples taken from the infected region and four consecutive blood cultures yielded C. septicum. His condition gradually improved postoperatively; however, on postoperative day 10, massive hemorrhage due to aortic rupture resulted in his death. CONCLUSIONS In this patient, C. septicum was thought to have entered his blood through a gastrointestinal tumor, infected the aorta, and spread to his kidneys. However, we were uncertain whether there was an associated malignancy. A literature review of C. septicum-related aneurysms revealed the following: 6-month mortality, 79.5%; periaortic gas present in 92.6% of cases; no standard operative procedure and no guidelines for antimicrobial administration established; and C. septicum was associated with cancer in 82.5% of cases. Thus, we advocate for early diagnosis via the identification of periaortic gas, as an aortic aneurysm progresses rapidly. To reduce the risk of reinfection as well as infection of other sites, there is the need for concurrent surgical management of the aneurysm and any associated malignancy. We recommend debridement of the infectious focus and in situ vascular graft with omental coverage. Postoperatively, orally administered antibiotics must be continued indefinitely (chronic suppression therapy). We believe that these treatments will decrease mortality due to C. septicum-infected aortic aneurysms.
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Affiliation(s)
- Fumihito Ito
- Department of Emergency and Critical Care Medicine, Ohta Nishinouchi Hospital, 2-5-20 Nishinouchi, Koriyama, Fukushima, 963-8558, Japan.
| | - Ryota Inokuchi
- Department of Emergency and Critical Care Medicine, JR General Hospital, 2-1-3 Yoyogi, Shibuya-ku, Tokyo, 151-8528, Japan.,Department of Emergency and Critical Care Medicine, The University of Tokyo Hospital, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Akinori Matsumoto
- Department of Emergency and Critical Care Medicine, Ohta Nishinouchi Hospital, 2-5-20 Nishinouchi, Koriyama, Fukushima, 963-8558, Japan
| | - Yoshibumi Kumada
- Department of Emergency and Critical Care Medicine, Ohta Nishinouchi Hospital, 2-5-20 Nishinouchi, Koriyama, Fukushima, 963-8558, Japan
| | - Hideyuki Yokoyama
- Department of Emergency and Critical Care Medicine, Ohta Nishinouchi Hospital, 2-5-20 Nishinouchi, Koriyama, Fukushima, 963-8558, Japan
| | - Tokiya Ishida
- Department of Emergency and Critical Care Medicine, Ohta Nishinouchi Hospital, 2-5-20 Nishinouchi, Koriyama, Fukushima, 963-8558, Japan
| | - Katsuhiko Hashimoto
- Department of Emergency and Critical Care Medicine, Ohta Nishinouchi Hospital, 2-5-20 Nishinouchi, Koriyama, Fukushima, 963-8558, Japan
| | - Masashi Narita
- Department of Infectious Diseases, Okinawa Chubu Hospital, 281 Miyazato, Uruma, Okinawa, 904-2293, Japan
| | - Kazuaki Shinohara
- Department of Emergency and Critical Care Medicine, Ohta Nishinouchi Hospital, 2-5-20 Nishinouchi, Koriyama, Fukushima, 963-8558, Japan
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Infrarenal Infected Aortic Aneurysm Caused by Streptococcus pyogenes. Case Rep Surg 2017; 2017:9329504. [PMID: 28503338 PMCID: PMC5414497 DOI: 10.1155/2017/9329504] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2016] [Accepted: 02/28/2017] [Indexed: 11/21/2022] Open
Abstract
Infectious aneurysm is a rare entity associated with significant morbidity and mortality. Current knowledge on pathogenesis, outcome, diagnosis, management, and follow-up remains debatable. We report the case of a patient with Streptococcus pyogenes aneurysm who was successfully treated with a homograft implant and discuss microbiological characteristics, diagnostic methods, and treatment options currently available for this serious disease.
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Wilson WR, Bower TC, Creager MA, Amin-Hanjani S, O’Gara PT, Lockhart PB, Darouiche RO, Ramlawi B, Derdeyn CP, Bolger AF, Levison ME, Taubert KA, Baltimore RS, Baddour LM. Vascular Graft Infections, Mycotic Aneurysms, and Endovascular Infections: A Scientific Statement From the American Heart Association. Circulation 2016; 134:e412-e460. [DOI: 10.1161/cir.0000000000000457] [Citation(s) in RCA: 215] [Impact Index Per Article: 26.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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Abstract
Radiographic documentation of the rapid development of an aortic infection has not previously been reported. We report the case of a 68-year-old woman who presented with back pain. A computed tomographic(CT) scan documented a nondisplaced L1 compression fracture as well as an atherosclerotic but nonaneurysmal aorta. Two weeks after discharge, she developed left lower lobe pneumonia and was readmitted. A second CT scan was obtained because of continuous complaints of back pain. A contained rupture of the visceral aorta was now clearly visible. Emergent operation successfully repaired her aorta. The microorganisms responsible for aortic infection have changed since the widespread use of antibiotics. Patterns of aortic involvement have also evolved. The difficulty in making these diagnoses, the role of current antibiotic therapy, and the surgical options for these infections will be discussed.
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Affiliation(s)
- Shannon Lehner
- Department of Surgery, Saint Louis University School of Medicine, St. Louis, MO, USA
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Zizi O, Jiber H, Bouarhroum A. Aortite infectieuse à Streptococcus pneumoniae. ACTA ACUST UNITED AC 2016; 41:36-41. [DOI: 10.1016/j.jmv.2015.12.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2015] [Accepted: 11/28/2015] [Indexed: 01/16/2023]
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Unosawa S, Niino T. An Infected Abdominal Aortic Aneurysm Caused by Helicobacter cinaedi. Ann Vasc Dis 2015; 8:318-20. [PMID: 26730258 DOI: 10.3400/avd.cr.15-00050] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2015] [Accepted: 08/29/2015] [Indexed: 11/13/2022] Open
Abstract
We present a rare case of an infected abdominal aortic aneurysm due to Helicobacter cinaedi that was detected by blood culture. A 79-year-old man with lumbago and left lower quadrant pain was admitted for the treatment of an infected abdominal aortic aneurysm. H. cinaedi was isolated from a blood culture, which was obtained on admission. The aneurysm was successfully treated with antibiotic therapy, aneurysmectomy, debridement, replacement of a bifurcated Dacron prosthesis, and omental wrapping. Our present case suggests that H. cinaedi should be considered as the causative agent of an infected aortic aneurysm.
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Affiliation(s)
- Satoshi Unosawa
- Department of Cardiovascular Surgery, National Hospital Organization Disaster Medical Center, Tokyo, Japan
| | - Tetsuya Niino
- Department of Cardiovascular Surgery, National Hospital Organization Disaster Medical Center, Tokyo, Japan
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Hagiya H, Matsumoto M, Furukawa H, Murase T, Otsuka F. Mycotic abdominal aortic aneurysm caused by Campylobacter fetus: a case report and literature review. Ann Vasc Surg 2014; 28:1933.e7-1933.e14. [PMID: 25017776 DOI: 10.1016/j.avsg.2014.06.072] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2014] [Revised: 05/24/2014] [Accepted: 06/19/2014] [Indexed: 10/25/2022]
Abstract
Campylobacter spp. usually cause gastrointestinal infections, but among them, Campylobacter fetus is a well-known organism causing mycotic abdominal aortic aneurysm (MAAA), which requires proper surgical intervention and antibiotic therapy. We report a 65-year-old man who was successfully treated by an in situ operation using a rifampicin (RFP)-bonded J-Graft for C. fetus-induced MAAA. We performed a review of the English literature on MAAA caused by C. fetus and summarized the results of the cases (28 cases). All but 2 of the patients (92.9%) were men. Blood culture and arterial wall culture were positive in 63% and 73.1% of the cases, respectively. Aneurysm rupture was seen in half of the patients, and approximately half of those patients died. Among the 18 patients who underwent in situ graft replacement, only 1 patient (5.6%) died after surgery. Antibiotic therapy was performed for more than 1 month in most cases, and overall mortality rate was 25.9% (7 of 27 cases, 3 deaths before the operation and 4 deaths after surgery). Although extra-anatomic bypass has been conventionally performed after complete resection of an MAAA, the utility of in situ surgery has generally been recognized. Our review suggests that the in situ operation can be a choice also in cases of C. fetus-associated MAAA. Furthermore, our case suggested the clinical utility of a newly manufactured prosthetic graft, J-Graft, for such surgical treatment.
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Affiliation(s)
- Hideharu Hagiya
- Department of General Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan; Emergency Unit and Critical Care Center, Tsuyama Central Hospital, Okayama, Japan.
| | - Mitsuaki Matsumoto
- Department of Cardiovascular Surgery, Tsuyama Central Hospital, Okayama, Japan
| | - Hiroshi Furukawa
- Department of Cardiovascular Surgery, Tsuyama Central Hospital, Okayama, Japan
| | - Tomoko Murase
- Microbiology Division, Department of Clinical Laboratory, Tsuyama Central Hospital, Okayama, Japan
| | - Fumio Otsuka
- Department of General Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
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Huang YK, Chen CL, Lu MS, Tsai FC, Lin PL, Wu CH, Chiu CH. Clinical, microbiologic, and outcome analysis of mycotic aortic aneurysm: the role of endovascular repair. Surg Infect (Larchmt) 2014; 15:290-8. [PMID: 24800865 DOI: 10.1089/sur.2013.011] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND Mycotic aortic aneurysm (MAA) is an infrequent but devastating form of vascular disease. METHODS We conducted a retrospective cohort study at a major medical center to identify independent risk factors for MAA and to provide opinions about treating it. The study population consisted of 43 patients who had had 44 MAAs over a period of 15 y. RESULTS All of the patients had positive blood cultures, radiologic findings typical of MAA, and clinical signs of infection (leukocytosis, fever, and elevated C-reactive protein). The mean age of the patients was 63.8±10.6 y and the mean period of their follow up was 35.7±39.3 mo. Twenty-nine patients with MAAs underwent traditional open surgery, 11 others received endovascular stent grafts, and four MAAs were managed conservatively. The most frequent causative pathogens were Salmonella (36/44 patients [81.8%]), in whom organisms of Salmonella serogroup C (consisting mainly of S. choleraesuis) were identified in 14 patients, organisms of Salmonella serogroup D were identified in 13 patients, and species without serogroup information were identified in nine patients. The overall mortality in the study population was 43.2% (with an aneurysm-related mortality of 18.2%, surgically related mortality of 13.6%, and in-hospital mortality of 22.7%). CONCLUSIONS Shock is a risk factor for operative mortality. Misdiagnosis and treatment of MAA as low back pain, co-existing connective-tissue disease such as systemic lupus erythematosus and rheumatoid arthritis, and Salmonella serogroup C-associated bacteremia are risk factors for aneurysm-related death. Endovascular repair should be considered as an alternative option to the open repair of MAA.
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Affiliation(s)
- Yao-Kuang Huang
- 1 Graduate Institute of Clinical Medicine, College of Medicine, Taipei Medical University , Taipei, Taiwan
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24
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Huang YK, Ko PJ, Chen CL, Tsai FC, Wu CH, Lin PJ, Chiu CH. Therapeutic Opinion on Endovascular Repair for Mycotic Aortic Aneurysm. Ann Vasc Surg 2014; 28:579-89. [DOI: 10.1016/j.avsg.2013.07.009] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2012] [Revised: 07/02/2013] [Accepted: 07/25/2013] [Indexed: 12/18/2022]
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Murakami M, Morikage N, Samura M, Yamashita O, Suehiro K, Hamano K. Fluorine-18-fluorodeoxyglucose positron emission tomography-computed tomography for diagnosis of infected aortic aneurysms. Ann Vasc Surg 2013; 28:575-8. [PMID: 24200128 DOI: 10.1016/j.avsg.2013.04.013] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2012] [Revised: 04/15/2013] [Accepted: 04/26/2013] [Indexed: 01/31/2023]
Abstract
BACKGROUND Infected aortic aneurysms are diagnosed on the basis of a positive bacterial blood culture, clinical evidence of inflammation, and morphologic findings on computed tomography (CT). However, preoperative diagnosis is often difficult because blood cultures are frequently negative and patients can be asymptomatic. Because therapeutic approaches differ significantly, it is vital to determine whether an aortic aneurysm is infected prior to surgery. METHODS From June 2007 to July 2012, we investigated 11 cases of suspected infected aortic aneurysm using fluorine-18-fluorodeoxyglucose positron emission tomography-computed tomography ((18)F-FDG-PET/CT). In addition to contrast-enhanced CT examination, blood culture and histologic examinations were performed to aid diagnosis. RESULTS Patients with a final diagnosis of infected aortic aneurysms showed a maximum standard uptake value (SUVmax) of >4.46, whereas infection-free cases had an SUVmax of <2.59 (mean 6.5 ± 1.8 vs. 1.9 ± 0.5; P < 0.001). CONCLUSION FDG-PET/CT examination is useful in the diagnosis of infected aortic aneurysms.
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Affiliation(s)
- Masanori Murakami
- Division of Vascular Surgery, Department of Surgery and Clinical Science, Yamaguchi University Graduate School of Medicine, Yamaguchi, Japan.
| | - Noriyasu Morikage
- Division of Vascular Surgery, Department of Surgery and Clinical Science, Yamaguchi University Graduate School of Medicine, Yamaguchi, Japan
| | - Makoto Samura
- Division of Vascular Surgery, Department of Surgery and Clinical Science, Yamaguchi University Graduate School of Medicine, Yamaguchi, Japan
| | - Osamu Yamashita
- Division of Vascular Surgery, Department of Surgery and Clinical Science, Yamaguchi University Graduate School of Medicine, Yamaguchi, Japan
| | - Kotaro Suehiro
- Division of Vascular Surgery, Department of Surgery and Clinical Science, Yamaguchi University Graduate School of Medicine, Yamaguchi, Japan
| | - Kimikazu Hamano
- Division of Vascular Surgery, Department of Surgery and Clinical Science, Yamaguchi University Graduate School of Medicine, Yamaguchi, Japan
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Canaud L, Ozdemir BA, Bee WW, Bahia S, Holt P, Thompson M. Thoracic endovascular aortic repair in management of aortoesophageal fistulas. J Vasc Surg 2013; 59:248-54. [PMID: 24199764 DOI: 10.1016/j.jvs.2013.07.117] [Citation(s) in RCA: 74] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2013] [Revised: 07/29/2013] [Accepted: 07/29/2013] [Indexed: 12/22/2022]
Abstract
OBJECTIVE To provide a systematic review of the outcomes of thoracic endovascular aortic repair (TEVAR) for aortoesophageal fistula (AEF) and to identify prognostic factors associated with poor outcomes. METHODS Literature searches of the Embase, Medline, and Cochrane databases identified relevant articles reporting results of TEVAR for AEF. The main outcome measure was the composite of aortic mortality, recurrence of the AEF, and stent graft explantation. The secondary outcome measure was aortic-related mortality. RESULTS Fifty-five articles were integrated after a literature search identified 72 patients treated by TEVAR for AEFs. The technical success rate of TEVAR was 87.3%. The overall 30-day mortality was 19.4%. Prolonged antibiotics (>4 weeks) were administered in 80% of patients. Concomitant or staged resection or repair of the esophagus was performed in 44.4% of patients. Stent graft explantation was performed within the first month after TEVAR as a planned treatment in 11.1%. After a mean follow-up of 7.4 months (range, 1-33 months), the all-cause mortality was 40.2%, and the aortic-related mortality was 33.3. Prolonged antibiotic treatment (P = .001) and repair of AEFs due to a foreign body (P = .038) were associated with a significant lower aortic mortality. On univariate analysis, TEVAR and concomitant or staged adjunctive procedures (resection, repair of the esophagus, or a planned stent graft explantation) were associated with a significantly lower incidence of aortic-related mortality (P = .0121). When entered into a binary logistic regression analysis, prolonged antibiotic treatment was the only factor associated with a significant lower incidence of the endpoint (P = .003). CONCLUSIONS Late infection or recurrence of the AEF and associated mortality rates are high when TEVAR is used as a sole therapeutic strategy. Prolonged antibiotic treatment has a strong negative association with mortality. A strategy of a temporizing endovascular procedure to stabilize the patient in extremis, and upon recovery, an open surgical esophageal repair with or without stent graft explantation is advocated.
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Affiliation(s)
- Ludovic Canaud
- Department of Outcomes Research, St George's Vascular Institute, London, United Kingdom.
| | - Baris Ata Ozdemir
- Department of Outcomes Research, St George's Vascular Institute, London, United Kingdom
| | - William Wynter Bee
- Department of Outcomes Research, St George's Vascular Institute, London, United Kingdom
| | - Sandeep Bahia
- Department of Outcomes Research, St George's Vascular Institute, London, United Kingdom
| | - Peter Holt
- Department of Outcomes Research, St George's Vascular Institute, London, United Kingdom
| | - Matt Thompson
- Department of Outcomes Research, St George's Vascular Institute, London, United Kingdom
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Lee CH, Hsieh HC, Ko PJ, Chou AH, Yu SY. Treatment of infected abdominal aortic aneurysm caused by Salmonella. Ann Vasc Surg 2013; 28:217-26. [PMID: 24084275 DOI: 10.1016/j.avsg.2013.02.021] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2012] [Revised: 12/23/2012] [Accepted: 02/06/2013] [Indexed: 11/30/2022]
Abstract
BACKGROUND We reviewed the outcomes of patients treated for nontyphoidal Salmonella-infected abdominal aortic aneurysm (AAA) treatment at a single center. METHODS This was a retrospective chart review of 26 patients with nontyphoidal Salmonella-infected AAA. Four patients underwent medical therapy alone, while 22 patients underwent surgical therapy. Revascularization method selection was dependent on preoperative antibiotic response in the surgical therapy group. RESULTS The in-hospital mortality rate for the surgical therapy group was 14%, while the rate for the medical therapy group was 100%. Overall survival for the surgical therapy group was 82%, while the reinfection rate was 9%. In the surgical therapy group, 2 patients had periaortic abscesses and underwent in situ prosthetic graft replacement; none developed graft-related complications or died in the hospital. Kaplan-Meier analysis and log-rank testing revealed no significant differences in graft-related complication and overall survival rates between in situ prosthetic graft group and extra-anatomic bypass group. Salmonella choleraesuis had a higher antimicrobial resistance rate than other isolates. The predictors of survival were clinical presentation of abdominal pain and receiving surgical therapy. CONCLUSIONS If patients with Salmonella-infected AAAs have good responses to preoperative antibiotic therapy, in situ prosthetic graft replacement is a viable revascularization method, even in the situation of periaortic abscess presentation formation.
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Affiliation(s)
- Chun-Hui Lee
- Department of Anesthesiology, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan
| | - Hung-Chang Hsieh
- Division of Thoracic and Cardiovascular Surgery, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan
| | - Po-Jen Ko
- Division of Thoracic and Cardiovascular Surgery, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan
| | - An-Hsun Chou
- Department of Anesthesiology, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan
| | - Sheng-Yueh Yu
- Division of Thoracic and Cardiovascular Surgery, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan.
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Canaud L, Ozdemir BA, Bahia S, Hinchliffe R, Loftus I, Thompson M. Thoracic Endovascular Aortic Repair for Aortobronchial Fistula. Ann Thorac Surg 2013; 96:1117-21. [DOI: 10.1016/j.athoracsur.2013.04.090] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2013] [Revised: 04/12/2013] [Accepted: 04/15/2013] [Indexed: 10/26/2022]
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Fang QB, Ge XH, Guan S, Sai LM, Ren H, Tian GL. Experience with Diagnosis and Treatment of Infected Abdominal Aortic Aneurysms: An Analysis of Seven Cases. Am Surg 2013. [DOI: 10.1177/000313481307900406] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Qing-Bo Fang
- Department of Vascular Surgery Xinjiang Uyghur Autonomous Region People Hospital Urumqi City, China
| | - Xiao-Hu Ge
- Department of Vascular Surgery Xinjiang Uyghur Autonomous Region People Hospital Urumqi City, China
| | - Sheng Guan
- Department of Vascular Surgery Xinjiang Uyghur Autonomous Region People Hospital Urumqi City, China
| | - Li-Mu Sai
- Department of Vascular Surgery Xinjiang Uyghur Autonomous Region People Hospital Urumqi City, China
| | - Hao Ren
- Department of Vascular Surgery Xinjiang Uyghur Autonomous Region People Hospital Urumqi City, China
| | - Guang-Lei Tian
- Department of Vascular Surgery Xinjiang Uyghur Autonomous Region People Hospital Urumqi City, China
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Lai CH, Chang RS, Luo CY, Kan CD, Lin PY, Yang YJ. Mycotic Aneurysms in the Abdominal Aorta and Iliac Arteries: CT-based Grading and Correlation with Surgical Outcomes. World J Surg 2012. [DOI: 10.1007/s00268-012-1850-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
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Lai CH, Luo CY, Lin PY, Kan CD, Chang RS, Wu HL, Yang YJ. Surgical Consideration of In Situ Prosthetic Replacement for Primary Infected Abdominal Aortic Aneurysms. Eur J Vasc Endovasc Surg 2011; 42:617-24. [DOI: 10.1016/j.ejvs.2011.07.005] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2011] [Accepted: 07/05/2011] [Indexed: 11/17/2022]
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Lee CH, Hsieh HC, Ko PJ, Li HJ, Kao TC, Yu SY. In situ versus extra-anatomic reconstruction for primary infected infrarenal abdominal aortic aneurysms. J Vasc Surg 2011; 54:64-70. [DOI: 10.1016/j.jvs.2010.12.032] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2010] [Revised: 11/30/2010] [Accepted: 12/02/2010] [Indexed: 01/16/2023]
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Kwon TW, Kim HK, Moon KM, Cho YP, Park SJ. In situ polytetrafluoroethylene graft bypass for primary infected aneurysm of the infrarenal abdominal aorta. World J Surg 2011; 34:1689-95. [PMID: 20238215 DOI: 10.1007/s00268-010-0507-3] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Reinfection is a major issue of surgical treatment for patients with infected abdominal aortic aneurysm (AAA). The present report describes outcomes after use of our procedure for treating patients with infected aneurysm of the infrarenal abdominal aorta. The procedure involved an in situ polytetrafluoroethylene (PTFE) graft bypass and omental wrapping of the graft. The procedure was used regardless of the presence of Gram-stain-positive pus or tissue or the type of pathogen identified. METHODS We retrospectively reviewed nine consecutive patients with primary infected aneurysms of the infrarenal abdominal aorta treated from June 2001 to August 2006 at the Asan Medical Center, Seoul, Korea. Diagnosis was based on preoperative abdominopelvic CT scans. Treatment involved removal of all infected tissue, including infected aorta tissue, in situ PTFE graft reconstruction, and wrapping of the graft with retrocolically transposed great omentum. Sensitive antibiotics were administered before and after the operation. RESULTS In all cases, aneurysms were the result of aortitis and aortic wall perforation, and presented as aortic pseudoaneurysms with rupture. The pathogens identified were Salmonella non-typhi (n = 4), Klebsiella pneumoniae (n = 2), Streptococcus pneumoniae (n = 1), Citrobacter freundii (n = 1), and Brucella abortus (n = 1). There was no infection-related morbidity or mortality during a median follow-up period of 49 months. CONCLUSIONS Surgical treatment comprising complete removal of all infected tissue, in situ PTFE graft reconstruction, and omental wrapping of the graft was effective in treating infected AAA. Key adjunct procedures were a precise preoperative diagnosis using abdominopelvic CT scans, and pre- and postoperative sensitive antibiotic treatment.
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Affiliation(s)
- Tae-Won Kwon
- Division of Vascular Surgery, Department of Surgery, University of Ulsan College of Medicine and Asan Medical Center, 388-1 Pungnap-2dong, Sonpa-gu, Seoul, 138-736, Korea.
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Cartery C, Astudillo L, Deelchand A, Moskovitch G, Sailler L, Bossavy JP, Arlet P. Abdominal Infectious Aortitis Caused by Streptococcus pneumoniae: A Case Report and Literature Review. Ann Vasc Surg 2011; 25:266.e9 - 16. [DOI: 10.1016/j.avsg.2010.07.014] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2009] [Revised: 06/27/2010] [Accepted: 07/23/2010] [Indexed: 01/16/2023]
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36
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Sène D, Cacoub P. Expressions Vasculaires des Maladies Infectieuses. TRAITÉ DE MÉDECINE VASCULAIRE. 2011. [PMCID: PMC7151833 DOI: 10.1016/b978-2-294-71346-0.50023-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Dubois M, Daenens K, Houthoofd S, Peetermans W, Fourneau I. Treatment of Mycotic Aneurysms with Involvement of the Abdominal Aorta: Single-centre Experience in 44 Consecutive Cases. Eur J Vasc Endovasc Surg 2010; 40:450-6. [DOI: 10.1016/j.ejvs.2010.07.017] [Citation(s) in RCA: 93] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2010] [Accepted: 07/24/2010] [Indexed: 02/06/2023]
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Brossier J, Lesprit P, Marzelle J, Allaire E, Becquemin JP, Desgranges P. New bacteriological patterns in primary infected aorto-iliac aneurysms: a single-centre experience. Eur J Vasc Endovasc Surg 2010; 40:582-8. [PMID: 20843713 DOI: 10.1016/j.ejvs.2010.07.020] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2010] [Accepted: 07/28/2010] [Indexed: 10/19/2022]
Abstract
OBJECTIVES To assess causative pathogens and surgical outcomes in patients with primary infected aorto-iliac aneurysms at our institution. DESIGN Retrospective study of patients treated at a university hospital between 1992 and 2009. RESULTS We identified 26 patients (median age, 63 years) with primary infected aneurysms on the aorta (descending thoracic, n = 2; thoraco-abdominal, n = 3; suprarenal, n = 2; infrarenal, n = 15) or iliac arteries (n = 4). Among them, 22 were symptomatic, including 13 with ruptured aneurysms. The causative organisms, identified in 25/26 patients, were Campylobacter fetus, n = 6; Streptococcus pneumoniae, n = 4; Listeria, n = 3; Salmonella, n = 2; Mycobacterium tuberculosis, n = 2; Staphylococcus aureus, n = 1; and other, n = 7. Immune suppression was a feature in 10 (38.4%) patients. Revascularisation was performed in situ in 23 patients (10 allografts, eight grafts, three superficial femoral veins, and 2 stentgrafts) and by extra-anatomic bypass in three patients. Hospital mortality was 23% (in situ group, 17.4%; extra-anatomic group, 66.7%; χ(2)(Yates), P = 0.24). During follow-up in the 20 survivors (median, 48.5 months), there were two non-infection-related deaths (five and 24 months) and six (30%) vascular complications. CONCLUSIONS The bacteriological spectrum of primary infected aorto-iliac aneurysms was wider than previously reported. The availability of new diagnostic tests and increased prevalence of immunosuppression may explain this finding.
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Affiliation(s)
- J Brossier
- Department of Vascular Surgery, Henri Mondor Hospital, AP/HP, University Paris Val de Marne, Créteil 94000, Paris, France
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39
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Primary Aortoenteric Fistula Due to Septic Aortitis. Ann Vasc Surg 2010; 24:825.e7-11. [DOI: 10.1016/j.avsg.2010.02.030] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2009] [Revised: 11/04/2009] [Accepted: 02/18/2010] [Indexed: 11/23/2022]
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40
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Affiliation(s)
- Young-wook Kim
- Division of Vascular Surgery, Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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41
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Abstract
Melioidosis is an infective condition which is common in South East Asia. It can present in various forms like cutaneous abscess, pneumonia and severe septicaemia. However, melioidosis causing abdominal aortic pseudoaneurysms is extremely rare and a difficult condition to diagnose and treat. We present our management of two cases of abdominal aortic pseudoaneurysms secondary to melioidosis and their subsequent outcomes.
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Affiliation(s)
- Jaideepraj Rao
- Department of General Surgery, Tan Tock Seng Hospital, Singapore.
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42
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Klonaris C, Katsargyris A, Vasileiou I, Markatis F, Liapis CD, Bastounis E. Hybrid repair of ruptured infected anastomotic femoral pseudoaneurysms: Emergent stent-graft implantation and secondary surgical debridement. J Vasc Surg 2009; 49:938-45. [DOI: 10.1016/j.jvs.2008.10.063] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2008] [Revised: 10/28/2008] [Accepted: 10/30/2008] [Indexed: 10/21/2022]
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43
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In situ replacement with equine pericardial roll grafts for ruptured infected aneurysms of the abdominal aorta. J Vasc Surg 2009; 49:1041-5. [DOI: 10.1016/j.jvs.2008.11.053] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2008] [Revised: 11/13/2008] [Accepted: 11/13/2008] [Indexed: 11/24/2022]
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Lee WK, Mossop PJ, Little AF, Fitt GJ, Vrazas JI, Hoang JK, Hennessy OF. Infected (mycotic) aneurysms: spectrum of imaging appearances and management. Radiographics 2009; 28:1853-68. [PMID: 19001644 DOI: 10.1148/rg.287085054] [Citation(s) in RCA: 192] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Infected aneurysms are uncommon. The aorta, peripheral arteries, cerebral arteries, and visceral arteries are involved in descending order of frequency. Staphylococcus and Streptococcus species are the most common causative pathogens. Early clinical diagnosis of infected aneurysms is challenging owing to their protean manifestations. Clinically apparent infected aneurysms are often at an advanced stage of development or are associated with complications, such as rupture. Nontreatment or delayed treatment of infected aneurysms often has a poor outcome, with high morbidity and mortality from fulminant sepsis or hemorrhage. Current state-of-the-art imaging modalities, such as multidetector computed tomography and magnetic resonance imaging, have replaced conventional angiography as minimally invasive techniques for detection of infected aneurysms in clinically suspected cases, as well as characterization of infected aneurysms and vascular mapping for treatment planning in confirmed cases. Doppler ultrasonography allows noninvasive assessment for infected aneurysms in the peripheral arteries. Imaging features of infected aneurysms include a lobulated vascular mass, an indistinct irregular arterial wall, perianeurysmal edema, and a perianeurysmal soft-tissue mass. Perianeurysmal gas, aneurysmal thrombosis, aneurysmal wall calcification, and disrupted arterial calcification at the site of the infected aneurysm are uncommon findings. Imaging-guided endovascular stent-graft repair and embolotherapy can be performed in select cases instead of open surgery. Familiarity with the imaging appearances of infected aneurysms should alert the radiologist to the diagnosis and permit timely treatment, which may include endovascular techniques.
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Affiliation(s)
- Wai-Kit Lee
- Department of Medical Imaging, St Vincent's Hospital, University of Melbourne, Fitzroy, Victoria, Australia.
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45
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Aortoiliac aneurysms infected by Campylobacter fetus. J Vasc Surg 2008; 48:815-20. [DOI: 10.1016/j.jvs.2008.05.076] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2008] [Revised: 05/28/2008] [Accepted: 05/28/2008] [Indexed: 11/21/2022]
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46
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Aavik A, Lieberg J, Kals J, Pulges A, Kals M, Lepner U. Ten Years Experience of Treating Aorto-Femoral Bypass Graft Infection with Venous Allografts. Eur J Vasc Endovasc Surg 2008; 36:432-7. [DOI: 10.1016/j.ejvs.2008.06.034] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2008] [Accepted: 06/27/2008] [Indexed: 10/21/2022]
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47
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Leon LR, Rodriguez HE, Labropoulos N, Littooy FN, Psalms SB. Aortitis and Bacterial Endocarditis. Vascular 2008; 16:53-8. [DOI: 10.2310/6670.2007.00038] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
Aortitis is an inflammatory condition that can be due to numerous causes. It is a diagnostic quandary because it commonly shows similar clinical, pathologic, and aortographic features independently of the etiology. A case of aortitis, possibly secondary to bacterial endocarditis, initially misdiagnosed as an atherosclerotic aortic ulcer and managed with an endoprosthesis is presented. On the fourth postoperative day, the patient presented with fever and worsening abdominal pain, which was later diagnosed as infectious aortitis. It required débridement and replacement of the infrarenal aorta with a cadaveric cryopreserved allograft. This case emphasizes the need for early diagnosis and aggressive therapy to avoid life-threatening sequelae.
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Affiliation(s)
- Luis R. Leon
- *Department of Vascular Surgery, Southern Arizona Veterans Affairs Health Care System, Tucson, AZ; †University of Arizona Health Science Center, Tucson, AZ; ‡Northwestern University Medical Center, Chicago, IL; §University of Medicine and Dentistry, Newark, NJ; ‖Loyola University Medical Center, Maywood, IL
| | - Heron E. Rodriguez
- *Department of Vascular Surgery, Southern Arizona Veterans Affairs Health Care System, Tucson, AZ; †University of Arizona Health Science Center, Tucson, AZ; ‡Northwestern University Medical Center, Chicago, IL; §University of Medicine and Dentistry, Newark, NJ; ‖Loyola University Medical Center, Maywood, IL
| | - Nicos Labropoulos
- *Department of Vascular Surgery, Southern Arizona Veterans Affairs Health Care System, Tucson, AZ; †University of Arizona Health Science Center, Tucson, AZ; ‡Northwestern University Medical Center, Chicago, IL; §University of Medicine and Dentistry, Newark, NJ; ‖Loyola University Medical Center, Maywood, IL
| | - Fred N. Littooy
- *Department of Vascular Surgery, Southern Arizona Veterans Affairs Health Care System, Tucson, AZ; †University of Arizona Health Science Center, Tucson, AZ; ‡Northwestern University Medical Center, Chicago, IL; §University of Medicine and Dentistry, Newark, NJ; ‖Loyola University Medical Center, Maywood, IL
| | - Shemuel B. Psalms
- *Department of Vascular Surgery, Southern Arizona Veterans Affairs Health Care System, Tucson, AZ; †University of Arizona Health Science Center, Tucson, AZ; ‡Northwestern University Medical Center, Chicago, IL; §University of Medicine and Dentistry, Newark, NJ; ‖Loyola University Medical Center, Maywood, IL
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Keripe S, Slavik S, Oshodi T. Primary Aortoappendicular Fistula Arising from an Infected, Chronic, Contained, Ruptured Abdominal Aortic Aneurysm. Ann Vasc Surg 2006; 20:820-4. [PMID: 16783482 DOI: 10.1007/s10016-006-9084-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2006] [Revised: 01/16/2006] [Accepted: 02/17/2006] [Indexed: 11/29/2022]
Abstract
Gastrointestinal bleeding can be caused by a variety of pathologies. Primary aortoappendicular fistula is rare and, in our case, arose in addition to a chronic contained rupture sac of an abdominal aortic aneurysm. Clinical diagnosis is difficult. Aortic aneurysmorrhaphy along with extensive debridement and emphasis on antibiotic therapy is curative.
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Affiliation(s)
- S Keripe
- Pennine Acute Vascular Unit, Royal Oldham Hospital, Oldham, Manchester, UK
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50
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McCready RA, Bryant MA, Divelbiss JL, Chess BA, Chitwood RW, Paget DS. Arterial infections in the new millenium: an old problem revisited. Ann Vasc Surg 2006; 20:590-5. [PMID: 17039259 DOI: 10.1007/s10016-006-9107-y] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2006] [Revised: 04/21/2006] [Accepted: 05/22/2006] [Indexed: 10/24/2022]
Abstract
The natural history of infected aneurysms or arterial infections is characterized by rapid expansion leading to rupture, pseudoaneurysm formation, and sepsis. Treatment options include in situ grafting either with prosthetic or autogenous grafts or with cryopreserved allografts (CPAs), resection of the aneurysm with remote bypass grafting, and ligation. The purpose of this study was to review our recent experience with these infections and to present long-term follow-up with in situ CPAs. From January 2000 through June 2005, we treated nine patients with infected aneurysms and one patient with an infection without aneurysm formation. The infection involved the infrarenal abdominal aorta in six patients and the femoral artery in three patients. One patient had an infected splenic artery aneurysm. Aortic rupture occurred in five of the six patients with infected aortas. Two of the three patients with infected femoral aneurysms presented with recurrent hemorrhage. Of the six patients with aortic infections, five were treated with in situ CPAs. One patient was treated with aortic resection and axillofemoral grafting. Two patients with femoral aneurysms were treated with in situ CPAs, and the third patient underwent aneurysm resection and prosthetic grafting through the obturator foramen. The patient with the splenic aneurysm underwent combined valve replacement, aneurysm resection, and splenectomy. Three of the six patients with aortic infections died postoperatively, all of whom were septic at presentation. The cause of death in these three patients was multiple organ failure in two and overwhelming sepsis in one. The three survivors are alive and well with up to 5-year follow-up. The three patients with infected femoral aneurysms are alive and well with follow-up extending to 44 months. The patient with the splenic aneurysm is doing well. No recurrent infections have been noted among the survivors. The CPAs have remained structurally intact in all. The mortality rate among patients with abdominal aortic infections remains high and is likely related to their preoperative septic state. In situ grafting with CPAs appears to be a reasonable treatment option for arterial infections. CPAs appear to maintain their structural integrity and to be resistant to recurrent infection.
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MESH Headings
- Aged
- Aged, 80 and over
- Aneurysm, Infected/diagnostic imaging
- Aneurysm, Infected/microbiology
- Aneurysm, Infected/mortality
- Aneurysm, Infected/surgery
- Aortic Aneurysm, Abdominal/diagnostic imaging
- Aortic Aneurysm, Abdominal/microbiology
- Aortic Aneurysm, Abdominal/mortality
- Aortic Aneurysm, Abdominal/surgery
- Aortic Rupture/diagnostic imaging
- Aortic Rupture/microbiology
- Aortic Rupture/mortality
- Aortic Rupture/surgery
- Aortography
- Blood Vessels/transplantation
- Cryopreservation
- Female
- Femoral Artery/diagnostic imaging
- Femoral Artery/microbiology
- Femoral Artery/surgery
- Follow-Up Studies
- Humans
- Male
- Middle Aged
- Splenic Artery/diagnostic imaging
- Splenic Artery/microbiology
- Splenic Artery/surgery
- Time Factors
- Tomography, X-Ray Computed
- Transplantation, Homologous
- Treatment Outcome
- Vascular Surgical Procedures
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Affiliation(s)
- Robert A McCready
- Department of Vascular Surgery, Methodist Hospital (Clarian Health Partners, Inc.), Indianapolis, IN, USA.
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