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[Surgical Outcomes of Mycotic Aneurysm of the Aortic Arch]
Naoto Fukunaga1, Tatsuto Wakami, Akio Shimoji
1Department of Cardiovascular Surgery, Hyogo Prefectural Amagasaki General Medical Center, Amagasaki, Japan.
Abstract:
Mycotic aneurysm of the aortic arch is a rare, but critical entity. We reviewed our surgical experience of mycotic aneurysm of the aortic arch. Between January 2007 and December 2015, we operated on six patients who had mycotic aneurysm of the aortic arch. The mean age was 72 years old, and four males were included. Preoperative white blood cell count was 18,266/μl and C-reactive peptide was 18.5 μg/dl, respectively. The initial presentations included fever( n=2), hoarseness( n=2), weakness of a leg( n=1), dyspnea (n=1) and hemoptysis (n=1). Preoperative blood cultures were positive in three patients. All patients underwent a total aortic arch repair with a four-branched vascular tube, and five received pedicled omental grafting. One patient who did not receive pedicled omental grafting died of recurrence of infection on postoperative day 21, and the other died of multi-organ failure on postoperative day 77. We experienced tracheostomy( n=1), minor stroke( n=1), and atrial fibrillation( n=1). During the follow-up period, no recurrence of infection was observed in four survivors. Our surgical strategy is satisfactory to achieve good clinical outcomes.
Insights
Surgical repair of mycotic aortic arch aneurysms using vascular tubes and omental grafting shows promising outcomes. This strategy effectively manages this rare but critical condition, leading to good clinical results in survivors.
Area of Science:
- Cardiovascular Surgery
- Infectious Diseases
- Vascular Surgery
Background:
- Mycotic aneurysm of the aortic arch is a rare and life-threatening condition.
- Early diagnosis and effective treatment are crucial for patient survival.
Approach:
- A retrospective review of six patients with mycotic aortic arch aneurysms who underwent surgical repair between 2007 and 2015.
- Surgical intervention involved total aortic arch repair with a four-branched vascular tube.
- Five patients received additional pedicled omental grafting to aid infection control.
Key Points:
- The patient cohort had a mean age of 72 years, with elevated white blood cell counts and C-reactive peptide levels.
- Presenting symptoms were diverse, including fever, hoarseness, leg weakness, dyspnea, and hemoptysis.
- Preoperative blood cultures were positive in three patients, confirming infection.
Conclusions:
- Total aortic arch repair combined with pedicled omental grafting appears to be a satisfactory surgical strategy for mycotic aortic arch aneurysms.
- While complications such as infection recurrence, multi-organ failure, tracheostomy, stroke, and atrial fibrillation were observed, long-term outcomes in survivors were positive with no observed recurrence of infection.
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