Surgical considerations in aortitis. Part II: Mycotic aneurysms

Mycotic aneurysms were first described as the result of nonsyphilitic bacterial infection of the arterial wall. They were often caused by septic emboli from bacterial endocarditis and were much more common prior to the era of antibiotics. Although the aorta is most often affected, such aneurysms may arise in any artery. Classified according to their etiology as primary, secondary, and cryptic mycotic aneurysms, it is imperative that immediate treatment be instituted once the diagnosis is confirmed by angiography. The patient should be placed on high doses of antibiotics appropriate for the offending pathogens. The goal of surgical treatment is the complete removal of the infected aneurysm and preservation of the distal circulation. Alternate methods of treating these lesions include the use of bypass grafts and interposition grafts. The virulence of the offending pathogen and the sensitivity to antibiotic therapy play a significant role in the success of these procedures.