Acute Conditions Caused by Infectious Aortitis
30. Januar 2014
10. April 2014
24. September 2018 (online)
Infection of the aorta is rare but potentially very dangerous. Under normal circumstances the aorta is very resistant to infections. Following some afflictions, the infection can pass to the aorta from blood or the surrounding tissues. The authors present their 5-year experience with therapy of various types of infections of the abdominal aorta.
Methods: In the 5-year period between January 2008 and December 2012, the Surgical Clinic of the University Hospital in Pilsen treated 17 patients with acute infection of the abdominal aorta. They included 9 males and 8 females. The mean age was 73.05 years (58-90). The most common pathogens were Salmonella (7), Staphylococcus aureus (2), Klebsiella pneumoniae (1), Listeria monocytogenes (1), and Candida albicans (1). Two cases included mixed bacteria and no infectious agent was cultured in three cases. In 14 cases (82.6%) we decided on an open surgical solution, i.e., resection of the affected abdominal aorta, extensive debridement, and vascular reconstruction. In all of these 14 cases we decided on in situ reconstruction. Twelve cases were treated using silver-impregnated prostheses. An antibiotic impregnated graft was used in one case and fresh aortic allograft in one case. In one case (5.9%) we decided on an endovascular solution, i.e., insertion of a bifurcation stent graft and prolonged antibiotic therapy. In two cases (11.8%) we decided on conservative treatment, as both patients refused any surgical therapy.
Results: Morbidity was 47.2% (8 patients). In one case we had to perform reoperation of a patient on the 15th postoperative day to evacuate the postoperative hematoma. The 30-day mortality was 5.9% (1 patient). The hospital mortality was 11.8% (2 patients). One patient died on the 42nd postoperative day due to multiorgan failure following resection of perforated aortitis. During follow-up (average 3.5 years), we had no case of infection or thrombosis of the vascular prosthesis.
Conclusion: Patients with mycotic aneurysms or acute aortitides face a high risk of death. One can legitimately expect an increase of “aortic infections” to parallel the increase of immunocompromised individuals. Surgical procedures for infectious aortitis are always demanding and require excellent interdisciplinary cooperation, but, as this experience shows, can lead to midterm survival.
The work was supported by Research Project of Charles University in Prague P36.
- 1 Gornik HL, Creager MA. Aortitis. Circulation 2008; 117: 3039-3051 . 10.1161/CIRCULATIONAHA.107.760686
- 2 Samore MH, Wessolossky MA, Lewis SM, Shubrooks SJ, Karchmer AW. Frequency, risk factors, and outcome for bacteremia after percutaneous transluminal coronary angioplasty. Am J Cardiol 1997; 79: 873-877 . 10.1016/S0002-9149(97)00006-4
- 3 Andersen ND, Bhattacharya SD, Williams JB, McCann RL, Hughes GC. Mycotic aneurysm of the thoracoabdominal aorta in a child with end-stage renal disease. J Vasc Surg 2011; 54: 1161-1163 . 10.1016/j.jvs.2011.04.051
- 4 Miller DV, Oderich GS, Aubry MC, Panneton JM, Edwards WD. Surgical pathology of infected aneurysms of the descending thoracic and abdominal aorta: clinicopathologic correlations in 29 cases (1976 to 1999). Hum Pathol 2004; 35: 1112-1120 . 10.1016/j.humpath.2004.05.013
- 5 Svensson LG, Crawford ES. Aortic dissection and aortic aneurysm surgery: clinical observations, experimental investigations, and statistical analyses. Part I. Curr Probl Surg 1992; 29: 817-911 . 10.1016/0011-3840(92)90003-L
- 6 Luo CY, Ko WC, Kan CD, Lin PY, Yang YJ. In situ reconstruction of septic aortic pseudoaneurysm due to Salmonella or Streptococcus microbial aortitis: long-term follow-up. J Vasc Surg 2003; 38: 975-982 . 10.1016/S0741-5214(03)00549-4
- 7 Oz MC, Brener BJ, Buda JA, Todd G, Brenner RW, Goldenkranz RJ. , et al. A ten-year experience with bacterial aortitis. J Vasc Surg 1989; 10: 439-449 . 10.1067/mva.1989.14207
- 8 Fillmore AJ, Valentine R. Surgical mortality in patients with infected aortic aneurysms. J Am Coll Surg 2003; 196: 435-441 . 10.1016/S1072-7515(02)01607-1
- 9 Brown SL, Busuttil RW, Baker JD, Machleder HI, Moore WS, Barker WF. Bacteriologic and surgical determinants of survival in patients with mycotic aneurysms. J Vasc Surg 1984; 4: 541-547 . 10.1016/0741-5214(84)90040-5
- 10 da Silva RM, Lingaas PS, Geiran O, Tronstad L, Olsen I. Multiple bacteria in aortic aneurysms. J Vasc Surg 2003; 38: 1384-1389 . 10.1016/S0741-5214(03)00926-1
- 11 Rutherford R. Infected aneurysma. In Vascular Surgery, 6th edition, volume 2. Philadelphia: Elsevier Saunders; 2009: 1581-1583
- 12 Lopes R, Almeida J, Dias PJ, Pinho P, Maciel MJ. Infectious thoracic aortitis: a literature review. Clin Cardiol 2009; 32: 488-490 . 10.1002/clc.20578
- 13 Ting AC, Cheng SW, Ho P, Poon JT, Tsu JH. Surgical treatment of infected aneurysms and pseudoaneurysms of the thoracic and abdominal aorta. Am J Surg 2005; 189: 150-154 . 10.1016/j.amjsurg.2004.03.020
- 14 Staffa R, Kríz Z, Vlachovský R, Dvorák M, Novotný T, Bucek J. , et al. Autogenous superficial femoral vein for replacement of an infected aorto-ilio-femoral prosthetic graft. Rozhl Chir 2010; 89: 39-44
- 15 Koeppel TA, Gahlen J, Diehl S, Prosst RL, Dueber C. Mycotic aneurysm of the abdominal aorta with retroperitoneal abscess: successful endovascular repair. J Vasc Surg 2004; 40: 164-166 . 10.1016/j.jvs.2004.02.046
- 16 Berchtold C, Eibl C, Seelig MH, Jakob P, Schonleben K. Endovascular treatment and complete regression of an infected abdominal aortic aneurysm. J Endovasc Ther 2002; 9: 543-548 . 10.1583/1545-1550(2002)009<0543:ETACRO>2.0.CO;2
- 17 Kinney EV, Kaebnick HW, Mitchell RA, Jung MT. Repair of mycotic paravisceral aneurysm with a fenestrated stent-graft. J Endovasc Ther 2000; 7: 192-197 . 10.1583/1545-1550(2000)007<0192:ROMPAW>2.3.CO;2
- 18 Patetsios PP, Shutze W, Holden B, Garrett WV, Pearl GJ, Smith BL. , et al. Repair of a mycotic aneurysm of the infrarenal aorta in a patient with HIV, using a Palmaz stent and autologous femoral vein graft. Ann Vasc Surg 2002; 16: 521-523 . 10.1007/s10016-001-0070-3
- 19 Corso JE, Kasirajan K, Milner R. Endovascular management of ruptured, mycotic abdominal aortic aneurysm. Am Surg 2005; 71: 515-517
- 20 Madhavan P, McDonnell CO, Dowd MO, Sultan SA, Doyle M, Colgan MP. , et al. Suprarenal mycotic aneurysm exclusion using a stent with a partial autologous covering. J Endovasc Ther 2000; 7: 404-409 . 10.1583/1545-1550(2000)007<0404:SMAEUA>2.0.CO;2
- 21 Kim JG, Kwon JB, Park K, Lee J. Endovascular treatment of ruptured infected aortic aneurysm with sepsis. J Korean Surg Soc 2012; 83: 250-253 . 10.4174/jkss.2012.83.4.250
- 22 Sakamoto S, Yokoyama N, Kasai S, Tamori Y, Okajima T, Yoshimuta T. , et al. Serial assessment at computed tomography and fluorine-18-labeled deoxyglucose positron emission tomography for the diagnosis and treatment of nonaneurysmal infective aortitis. Can J Cardiol 2009; 25: 367 . 10.1016/S0828-282X(09)70101-1
- 23 Oderich GS, Panneton JM, Bower TC, Cherry KJ, Rowland CM, Noel AA. , et al. Infected aortic aneurysms: aggressive presentation, complicated early outcome, but durable results. J Vasc Surg 2001; 34: 900-908 . 10.1067/mva.2001.118084