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Surgical Treatment of Infected Aortoiliac Aneurysm.

Youn JK, Kim SM, Han A, Choi C, Min SI, Ha J, Kim SJ, Min SK - Vasc Specialist Int (2015)

Bottom Line: There were 3 in-hospital mortalities and the causes were sepsis in 2 and aneurysm rupture in 1.IAAA develops from various causes and various organisms.In situ reconstruction is favorable for long term-safety and efficacy, but extensive debridement is essential.

View Article: PubMed Central - PubMed

Affiliation: Department of Surgery, Seoul National University College of Medicine, Seoul, Korea.

ABSTRACT

Purpose: Infected aneurysms of the abdominal aorta or iliac artery (IAAA) are rare but fatal and difficult to treat. The purpose of this study was to review the clinical presentations and outcomes of IAAA and to establish a treatment strategy for optimal treatment of IAAA.

Materials and methods: Electronic medical records of 13 patients treated for IAAA at Seoul National University Hospital between March 2004 and December 2012 were retrospectively reviewed.

Results: Mean age was 64.2 (median 70, range 20-79) years. Aneurysms were located in the infrarenal aorta (n=7), iliac arteries (n=5), and suprarenal aorta (n=1). Seven patients underwent excision and in situ interposition graft, 3 underwent extra-anatomical bypass, and 1 underwent endovascular repair. One patient with endovascular repair in an outside hospital refused resection, and only debridement was done, which revealed tuberculosis infection. One staphylococcal infection was caused by iliac stenting. Mycobacterium was the most common pathogen, followed by Klebsiella, Salmonella, and Staphylococcus. There were 3 in-hospital mortalities and the causes were sepsis in 2 and aneurysm rupture in 1. The 3 extra-anatomic bypasses were all patent after 5-year follow-up.

Conclusion: IAAA develops from various causes and various organisms. IAAA cases with gross pus were treated with extra-anatomic bypass, which was durable. In situ reconstruction is favorable for long term-safety and efficacy, but extensive debridement is essential.

No MeSH data available.


Related in: MedlinePlus

Serial images of an infected stent-graft. (A) Computed tomography (CT) image before endovascular aneurysm repair (EVAR); (B) CT image after EVAR; (C) positron emission tomography-CT image after EVAR showing hot uptake around the stent-graft compatible with infection; (D) operative finding of the infected stent-graft with gross pus discharge.
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f1-vsi-31-41: Serial images of an infected stent-graft. (A) Computed tomography (CT) image before endovascular aneurysm repair (EVAR); (B) CT image after EVAR; (C) positron emission tomography-CT image after EVAR showing hot uptake around the stent-graft compatible with infection; (D) operative finding of the infected stent-graft with gross pus discharge.

Mentions: Among the 13 patients, 12 had a primary infected aortoiliac aneurysm and 1 patient had an infected aneurysm after stent insertion for iliac stenosis. Ten patients underwent curative surgery including in situ revascularization in 7 patients and extra-anatomical bypass in 3 patients. One patient had stent graft insertion with endovascular aneurysm repair (EVAR) due to poor general condition resulting from leukemia. One patient underwent EVAR at another hospital due to suspected contained rupture of a common iliac artery aneurysm was transferred due to aggravation of a periarterial low-density lesion with mild fever, which was confirmed as a tuberculosis infection after debridement and tissue culture. We suspect this was a primary infected aneurysm caused by tuberculosis (Fig. 1). Table 2 shows the clinical presentation of the patients who underwent in situ repair and extra-anatomical bypass.


Surgical Treatment of Infected Aortoiliac Aneurysm.

Youn JK, Kim SM, Han A, Choi C, Min SI, Ha J, Kim SJ, Min SK - Vasc Specialist Int (2015)

Serial images of an infected stent-graft. (A) Computed tomography (CT) image before endovascular aneurysm repair (EVAR); (B) CT image after EVAR; (C) positron emission tomography-CT image after EVAR showing hot uptake around the stent-graft compatible with infection; (D) operative finding of the infected stent-graft with gross pus discharge.
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4508656&req=5

f1-vsi-31-41: Serial images of an infected stent-graft. (A) Computed tomography (CT) image before endovascular aneurysm repair (EVAR); (B) CT image after EVAR; (C) positron emission tomography-CT image after EVAR showing hot uptake around the stent-graft compatible with infection; (D) operative finding of the infected stent-graft with gross pus discharge.
Mentions: Among the 13 patients, 12 had a primary infected aortoiliac aneurysm and 1 patient had an infected aneurysm after stent insertion for iliac stenosis. Ten patients underwent curative surgery including in situ revascularization in 7 patients and extra-anatomical bypass in 3 patients. One patient had stent graft insertion with endovascular aneurysm repair (EVAR) due to poor general condition resulting from leukemia. One patient underwent EVAR at another hospital due to suspected contained rupture of a common iliac artery aneurysm was transferred due to aggravation of a periarterial low-density lesion with mild fever, which was confirmed as a tuberculosis infection after debridement and tissue culture. We suspect this was a primary infected aneurysm caused by tuberculosis (Fig. 1). Table 2 shows the clinical presentation of the patients who underwent in situ repair and extra-anatomical bypass.

Bottom Line: There were 3 in-hospital mortalities and the causes were sepsis in 2 and aneurysm rupture in 1.IAAA develops from various causes and various organisms.In situ reconstruction is favorable for long term-safety and efficacy, but extensive debridement is essential.

View Article: PubMed Central - PubMed

Affiliation: Department of Surgery, Seoul National University College of Medicine, Seoul, Korea.

ABSTRACT

Purpose: Infected aneurysms of the abdominal aorta or iliac artery (IAAA) are rare but fatal and difficult to treat. The purpose of this study was to review the clinical presentations and outcomes of IAAA and to establish a treatment strategy for optimal treatment of IAAA.

Materials and methods: Electronic medical records of 13 patients treated for IAAA at Seoul National University Hospital between March 2004 and December 2012 were retrospectively reviewed.

Results: Mean age was 64.2 (median 70, range 20-79) years. Aneurysms were located in the infrarenal aorta (n=7), iliac arteries (n=5), and suprarenal aorta (n=1). Seven patients underwent excision and in situ interposition graft, 3 underwent extra-anatomical bypass, and 1 underwent endovascular repair. One patient with endovascular repair in an outside hospital refused resection, and only debridement was done, which revealed tuberculosis infection. One staphylococcal infection was caused by iliac stenting. Mycobacterium was the most common pathogen, followed by Klebsiella, Salmonella, and Staphylococcus. There were 3 in-hospital mortalities and the causes were sepsis in 2 and aneurysm rupture in 1. The 3 extra-anatomic bypasses were all patent after 5-year follow-up.

Conclusion: IAAA develops from various causes and various organisms. IAAA cases with gross pus were treated with extra-anatomic bypass, which was durable. In situ reconstruction is favorable for long term-safety and efficacy, but extensive debridement is essential.

No MeSH data available.


Related in: MedlinePlus