Infected aneurysms of the suprarenal abdominal aorta

• Published in: Journal of vascular surgery 2011-10, Vol.54 (4), p.972-978
• Main Authors: Hsu, Ron-Bin, MD, Chang, Chung-I., MD, Chan, Chih-Yang, MD, Wu, I-Hui, MD
• Format: Article
• Language: English
• Subjects: Adult; Aged; Aged, 80 and over; Aneurysm, Infected - diagnosis; Aneurysm, Infected - microbiology; Aneurysm, Infected - mortality; Aneurysm, Infected - therapy; Anti-Bacterial Agents - therapeutic use; Aortic Aneurysm, Abdominal - diagnosis; Aortic Aneurysm, Abdominal - microbiology; Aortic Aneurysm, Abdominal - mortality; Aortic Aneurysm, Abdominal - therapy; Biological and medical sciences; Blood and lymphatic vessels; Blood Vessel Prosthesis Implantation - adverse effects; Blood Vessel Prosthesis Implantation - mortality; Cardiology. Vascular system; Diseases of the aorta; Endovascular Procedures - adverse effects; Endovascular Procedures - mortality; Female; Hospital Mortality; Humans; Male; Medical sciences; Middle Aged; Retrospective Studies; Salmonella - isolation & purification; Staphylococcus aureus - isolation & purification; Streptococcus - isolation & purification; Surgery; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Taiwan; Time Factors; Treatment Outcome; Vascular surgery: aorta, extremities, vena cava. Surgery of the lymphatic vessels
• ISSN: 0741-5214; 1097-6809
• DOI: 10.1016/j.jvs.2011.04.024

Background Infected aneurysm of the suprarenal abdominal aorta is rare and can be fatal without surgery. There have been only sporadic case reports or small case series. We review our experience with 14 patients over 13 years. Methods Retrospective chart review. Results Between 1997 and 2010, 14 cases of infected aneurysms of the suprarenal abdominal aorta were treated at our hospital. There were 11 men with median age of 75.5 years (range, 35-88). Of the 13 pathogens isolated, the most common responsible microorganism was nontyphoid Salmonella in eight (62%) followed by Staphylococcus aureus in three (23%) and Streptococcus in two patients (15%). At the first admission, six patients had medical treatment alone, five patients underwent early open in situ graft repair, and three patients underwent hybrid endovascular stenting and visceral debranching. Of the six medically treated patients, two patients died in the hospital because of aneurysm rupture, and two patients underwent late open in situ graft repair because of aneurysm progression or rupture. Of the five open surgically treated patients, one patient died in the hospital because of nosocomial sepsis, and four patients were alive without major postoperative complication. Of the three endovascularly treated patients, one patient died in the hospital because of intestinal ischemia, one patient died 6 months later because of postoperative complication, and one patient was alive with complications of paraplegia, renal failure, and permanent dialysis. The aneurysm-related mortality rate was 33% (2/6) in medical treatment alone, 20% (1/5) in open in situ grafting, and 67% (2/3) in hybrid endovascular stenting. Conclusions Infected aneurysm of the suprarenal abdominal aorta was rare. Nontyphoid Salmonella was the most common responsible microorganism. Open in situ graft repair remained a preferred and durable treatment strategy.