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Ann Vasc Surg. 2014 Apr;28(3):579-89. doi: 10.1016/j.avsg.2013.07.009. Epub 2014 Jan 6.

Therapeutic opinion on endovascular repair for mycotic aortic aneurysm.

Author information

1
Graduate Institute of Clinical Medicines, College of Medicine, Taipei Medical University, Taipei, Taiwan; Division of Thoracic and Cardiovascular Surgery, Chang Gung Memorial Hospital, Chia-yi and Linkou center, Taoyuan, Taiwan; College of Medicine, Chang Gung University, Taoyuan, Taiwan.
2
Division of Thoracic and Cardiovascular Surgery, Chang Gung Memorial Hospital, Chia-yi and Linkou center, Taoyuan, Taiwan.
3
Division of Pediatric Infectious Diseases, Department of Pediatrics, Chang Gung Children's Hospital, Chang Gung University College of Medicine, Taoyuan, Taiwan.
4
Graduate Institute of Clinical Medicines, College of Medicine, Taipei Medical University, Taipei, Taiwan.
5
College of Medicine, Chang Gung University, Taoyuan, Taiwan; Division of Pediatric Infectious Diseases, Department of Pediatrics, Chang Gung Children's Hospital, Chang Gung University College of Medicine, Taoyuan, Taiwan. Electronic address: huang137@mac.com.

Abstract

BACKGROUND:

Our aim in this study was to assess the feasibility of endovascular repair for mycotic aortic aneurysms (MAAs) and to provide a therapeutic opinion.

METHODS:

We retrospectively reviewed the records of 12 patients who underwent endovascular repair for MAAs between September 2006 and June 2011.

RESULTS:

Patients consisted of 9 men and 3 women, with a median age of 64.6 years (range 45-75 years). The aortic aneurysms were in the thoracic/thoracoabdominal aorta in 5 patients, juxtarenal aorta with visceral involvement in 2 patients, and infrarenal abdominal aorta in 5 patients. Blood cultures of 10 patients (83.3%) were positive for bacteria and showed Salmonella species (8 patients), Klebsiella pneumonia (1 patient), and Escherichia coli (1 patients). Eight patients with active sepsis or active bleeding underwent emergent endovascular repair because of unstable hemodynamics. Notably, 2 patients required adjuvant surgery for complete removal of infectious foci. No deaths occurred within 30 days after intervention. We recorded 2 late deaths: 1 patient died of progressive pneumonia on day 39 after intervention and the other died of liver failure on day 58 after intervention. Late complications were observed in 3 patients, 1 of whom needed an aortic revision for late prosthesis infection. The mean follow-up time was 24 ± 19.7 months.

CONCLUSIONS:

Endovascular repair is a feasible therapeutic option for MAAs in that it can both stop bleeding and exclude the aneurysms. Although the aortic interventions performed were successful, the patients had an immunocompromised status and a difficult postoperative recovery. "Aggressive" surgical drainage may be necessary in some patients and may lead to a better outcome.

PMID:
24405771
DOI:
10.1016/j.avsg.2013.07.009
[Indexed for MEDLINE]
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