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Mycotic aortic aneurysms. A reappraisal
Abstract:
Mycotic aneurysms are uncommon but not rare lesions with potential for catastrophic hemorrhage or sepsis. They have been ascribed to bacterial endocarditis and, when present in the aorta, were termed "inevitably fatal" as recently as 1967. A 15-year review of the English-language literature on mycotic aneurysms showed that arterial trauma, concurrent sepsis, and depressed host immunity have become the cardinal "risk factors" in the development of these lesions. Conventional treatment of mycotic aortic aneurysms usually includes aortic ligation, aneurysmal excision, and extra-anatomic bypass grafting. Nevertheless, four of our patients with well-localized mycotic aortic aneurysms survived three to 54 months (mean, 40 months) after aortic excision and in situ prosthetic graft restoration of aortic continuity. This experience suggests that mycotic aortic aneurysms can be successfully treated, frequently by in situ grafting, if diagnosis and treatment are timely and aggressive.
Insights
Mycotic aneurysms, though serious, can be successfully treated. In situ grafting offers a viable option for aortic mycotic aneurysms when diagnosed and managed promptly.
Area of Science:
- Vascular Surgery
- Infectious Diseases
- Medical Literature Review
Background:
- Mycotic aneurysms are uncommon vascular lesions with high risks of hemorrhage and sepsis.
- Historically, aortic mycotic aneurysms were considered fatal, often linked to bacterial endocarditis.
Observation:
- A 15-year literature review identified arterial trauma, sepsis, and immune suppression as key risk factors.
- Conventional treatments included aortic ligation and bypass grafting.
Findings:
- Four patients with localized mycotic aortic aneurysms survived after aortic excision and in situ prosthetic graft restoration.
- Survival ranged from 3 to 54 months, averaging 40 months.
Implications:
- Timely diagnosis and aggressive treatment, particularly in situ grafting, can lead to successful outcomes for mycotic aortic aneurysms.
- This approach challenges the historical view of inevitable fatality for these conditions.