Infected abdominal aortic aneurysm: in situ replacement with cryopreserved arterial homograft

Infected aortic aneurysms are a rare (1.3% of all abdominal aortic aneurysms) but life-threatening disease. At present controversy continues about the specific diagnosis and the best surgical management. We present one case of infected aortic aneurysm treated with in situ reconstruction with cryopreserved arterial homograft. He was a 50-year-old man with recent history of pneumococcal meningitis who is readmitted because he suffered a stroke and during physical examination a pulsatile abdominal mass was discovered. Blood cultures were done and the result was repeatedly negative. Radiological studies were performed: the abdominal CT scanning showed a non ruptured 5 cm infrarenal aortic aneurysm with irregular wall and in the aortography it appeared eccentric, multilobulated with a clear neck in an otherwise normal size aorta but with some arteriosclerotic lesions. The diagnosis of infected aneurysm was suspected and the patient received antibiotic therapy and was operated on: aneurysm resection with wide debridement of surrounding tissues and in situ aortic replacement with aortobifemoral cryopreserved arterial homograft. Cultures of the aneurysm wall and contents were negative but aneurysm wall biopsy suggested an infected aortic aneurysm. The postoperative course was uneventful and antibiotics were continued for 6 weeks. The patient is doing well 7 months after surgery without signs of recurrent infection and normal appearance of the cryopreserved arterial homograft. We conclude that specific diagnosis of infected aortic aneurysms is essential for correct treatment but may be difficult, in these cases a history of infection supported by radiologic findings and aneurysm wall biopsy are of great value. Cryopreserved arterial homografts constitute a good alternative to prosthetic grafts for in situ reconstructions in the treatment of infected aortic aneurysms, decreasing the risk of re-infection or septic complications.