Surgical management of infected thoracic aneurysms

Infected thoracic aortic aneurysm (ITAA) is a relatively rare disease. The diagnosis of ITAA is generally made comprehensively based on symptoms, laboratory data and CT findings. Several series of blood cultures are mandatory to first detect the infecting organism. ITAA is usually suspected as a result of the CT findings. A short-interval CT re-examination is essential to confirm the correct diagnosis. A CT scan commonly demonstrates a rapid enlargement of the aneurismal lumen and soft tissue mass surrounding the aorta. One of the characteristics of ITAA is the presence of several nodular or saccular aneurysms localized in different aortic portions. Patients with ITAA are associated with high incidences of aneurismal rupture due to the aneurysm's abrupt growth. Therefore, ITAAs are associated with both high morbidities and mortalities. The major concerns regarding surgical treatment for ITAA are the control of infection, the resection of whole infected tissue, grafting via an aseptic route and the prevention of recrudescent infection. Therefore, effectual antibiotic therapy is mandatory as the first choice of therapy. Ideally surgical intervention is indicated in patients with a controlled infection. It is essential to excise the whole infected aneurysm and to reconstruct in-situ grafting via an aseptic route. However, urgent surgery is often required in patients with an uncontrolled infection because they have an impending aneurismal rupture. In such cases, an extra-anatomical bypass without cardiopulmonary bypass is applicable. Surgical strategies should therefore be determined on a case-by-case basis because these patients present various clinical courses.