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In Situ Reconstruction with Extended Debridement in Patients with Mycotic Abdominal Aortic Aneurysms
Youkou Nemoto1,2, Yutaka Hosoi2, Katsuyuki Hoshina1
1Division of Vascular Surgery, Department of Surgery, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
Abstract:
The surgical outcomes in patients with mycotic aortic aneurysm are still poor. In situ reconstruction and extra-anatomical bypass are the 2 main surgical options used in these patients, both of which have postoperative complications: recurrence of infection and aortic stump blowout, respectively. We performed in situ reconstruction in 25 consecutive patients with mycotic abdominal aortic aneurysms together with extended debridement using an irrigation device, omental flap coverage, rifampicin-soaked prosthetic graft, and sufficient antibiotics administration. There were 3 in-hospital mortalities; however, no infection- or procedure-related adverse events were observed in other cases during the mid-term follow-up period.
Insights
Surgical outcomes for mycotic aortic aneurysms remain poor. This study shows in situ reconstruction with advanced techniques significantly reduced infection and complications in patients with mycotic abdominal aortic aneurysms.
Area of Science:
- Vascular Surgery
- Infectious Diseases
- Surgical Innovation
Background:
- Mycotic aortic aneurysms present significant surgical challenges with high mortality.
- Current surgical options, in situ reconstruction and extra-anatomical bypass, have distinct, serious postoperative complications.
- In situ reconstruction risks infection recurrence, while extra-anatomical bypass risks aortic stump blowout.
Purpose of the Study:
- To evaluate the efficacy of a comprehensive in situ reconstruction technique for mycotic abdominal aortic aneurysms.
- To assess the mid-term safety and outcomes of this refined surgical approach.
- To determine if this method can mitigate the high complication rates associated with mycotic aortic aneurysms.
Main Methods:
- In situ reconstruction was performed on 25 consecutive patients diagnosed with mycotic abdominal aortic aneurysms.
- The procedure involved extended debridement with an irrigation device, omental flap coverage, and the use of a rifampicin-soaked prosthetic graft.
- Patients received sufficient antibiotic administration throughout their treatment course.
Main Results:
- Three in-hospital mortalities occurred within the study cohort.
- No infection-related adverse events were observed in the remaining patients during the mid-term follow-up period.
- No procedure-related adverse events, such as aortic stump blowout, were reported in the non-fatal cases.
Conclusions:
- This refined in situ reconstruction strategy offers promising mid-term results for mycotic abdominal aortic aneurysms.
- The combined approach of aggressive debridement, omental flap, antibiotic-soaked graft, and antibiotics effectively reduces infection and procedure-related complications.
- Further research with larger cohorts is warranted to confirm these findings and establish this technique as a standard of care.