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Infected abdominal aortic aneurysms. Experience with 14 consecutive cases
1Department of Surgery, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.
Abstract:
Fourteen patients with infected aortic aneurysms who were admitted to Chulalongkorn Hospital, Bangkok, Thailand from January 1990 to December 1995 were studied. Inclusion criteria were obvious infection found at operations and positive cultures of the aneurysmal sac or contents. Severity of infection found at operations was divided into no, mild, and severe periaortic infection. Eight patients who had no or mild periaortic infection underwent in situ grafting. All of them survived and were discharged home. Four of them are still well at present. None of them developed subsequent graft infection. Of the remaining 6 patients who had severe periaortic infection, one underwent drainage of the retroperitoneal abscess followed by excision of the infected aneurysm and axillobifemoral bypass 2 weeks later. This patient survived and was discharged home but died 4 months later from graft occlusion and sepsis. Of the remaining 5 patients, 3 had in situ grafting and 2 had axillobifemoral bypass. All of them died from sepsis and multiple organ failure in the early postoperative period. Positive culture for gram negative enteric bacteria were obtained in all patients. The study demonstrates that in situ grafting can be safety performed if there is no or only mild periaortic infection and adequate clearance of the infected aorta and periaortic tissue is obtained after an aggressive debridement. A long-term antibiotic administration is recommended.
Insights
In situ grafting for infected aortic aneurysms is safe with no or mild infection. Severe infections require alternative treatments, and long-term antibiotics are recommended.
Area of Science:
- Vascular Surgery
- Infectious Diseases
Background:
- Infected aortic aneurysms are life-threatening conditions requiring prompt and effective treatment.
- Treatment options for infected aortic aneurysms are limited and associated with high morbidity and mortality.
- Gram-negative enteric bacteria are common causative agents of aortic infections.
Purpose of the Study:
- To evaluate the safety and efficacy of in situ grafting for infected aortic aneurysms.
- To determine the impact of periaortic infection severity on treatment outcomes.
- To assess the role of long-term antibiotic therapy in managing infected aortic aneurysms.
Main Methods:
- Retrospective study of 14 patients with infected aortic aneurysms treated between 1990 and 1995.
- Classification of periaortic infection severity into no, mild, and severe.
- Surgical interventions included in situ grafting and axillobifemoral bypass.
- Microbiological analysis of aneurysmal sac or contents for bacterial cultures.
Main Results:
- Eight patients with no or mild periaortic infection underwent in situ grafting, all survived with no subsequent graft infection.
- Six patients with severe periaortic infection had poorer outcomes, with 5 out of 6 dying from sepsis or complications.
- Gram-negative enteric bacteria were identified in all positive cultures.
Conclusions:
- In situ grafting is a safe and effective option for infected aortic aneurysms with no or mild periaortic infection, provided adequate debridement.
- Severe periaortic infection is associated with significantly higher mortality, necessitating alternative surgical approaches.
- Long-term antibiotic administration is recommended for all patients with infected aortic aneurysms.