Long-term surgical outcome following repair of mycotic abdominal aortic aneurysms with associated vertebral spondylitis

Aims: The coexistence of aortic aneurysms and vertebral spondylitis is rare but challenging. The origin of the infection is commonly unknown but the latter maintained by the coexisting pathology.

Methods: Over a 3 year interval 6 patients (68.0±5.3yrs, 2 female) underwent surgical repair for the above diagnosis. Inpatient and outpatient records were examined.

Results: Patients presented with abdominal or back pain and signs of an ongoing systemic infection. CT revealed abdominal aortic aneurysms with a maximal diameter of 7.6±1.6cm, which were associated with polysegmental spondylitis extending between L2 and S1. Organisms were identified in all but one patient: pseudomonas aeroginosa, E.coli, corynebacteria, salmonella typhimurium, mycobacteria avium. Patients underwent radical debridement and aortic replacement with cryopreserved aortic allograft (50%) or silver-coated prosthesis (50%) followed by antibiotic treatment. Only one patient received a simultaneous anterior vertebral stabilisation. There was no in-hospital death. ICU and hospital stay were 9.0±15.8 and 27.0±17.1 days respectively. In one patient respiratory failure extended weaning. During follow-up of 9.8±5.1 months, survival rate was 67%. Two patients died unrelated at 7 and 8 months due to small bowel ischaemia and cardiac death. The initial follow up showed freedom from infection in all patients and only one had to undergo secondary vertebral stabilisation. The definitive origin of the infection remained unclear in all patients.

Conclusions: Surgical repair including resection of all infected tissues with simultaneous replacement of the aortic aneurysm achieved favourable results in this very sick patient group. The vertebral involvement can in the majority be managed conservatively.