Infected infrarenal aortic aneurysms: When is in situ reconstruction safe?

• Published in: Journal of vascular surgery Vol. 17; no. 4; pp. 635 - 645
• Main Authors: Fichelle, Jean Marc, Tabet, Georges, Cormier, Philippe, Farkas, Jean Christophe, Laurian, Claude, Gigou, Frédéric, Marzelle, Jean, Acar, Jacques, Cormier, Jean Michel
• Format: Journal Article
• Language: English
• Published: New York, NY Mosby, Inc 01-04-1993; Elsevier
• Subjects: Adult; Aged; Aneurysm, Infected - mortality; Aneurysm, Infected - surgery; Anti-Bacterial Agents - therapeutic use; Aorta, Abdominal - surgery; Aortic Aneurysm, Abdominal - mortality; Aortic Aneurysm, Abdominal - surgery; Aortic Rupture - mortality; Aortic Rupture - surgery; Biological and medical sciences; Blood Vessel Prosthesis; Combined Modality Therapy; Female; Follow-Up Studies; Humans; Male; Medical sciences; Middle Aged; Paris; Polyethylene Terephthalates; Postoperative Complications - epidemiology; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Survival Rate; Vascular surgery: aorta, extremities, vena cava. Surgery of the lymphatic vessels; Paris; Vascular disease; Abdominal aorta; Human; Infection; Plasty; Treatment; Indication; Prosthesis; Surgery; Aneurysm; Cardiovascular disease; Aortic disease
• ISSN: 0741-5214; 1097-6809
• DOI: 10.1016/0741-5214(93)90105-U

Twenty-five infected infrarenal aortic aneurysms operated on between 1968 and 1989 were reviewed. They were classified into postembolic (mycotic) aneurysms (group I), infective aortitis (group II), and infected atherosclerotic aneurysms (group III). Aortoduodenal fistulas were found in eight patients and aortocaval in two. Five patients were operated on in a state of shock, and 12 had preoperative positive blood cultures. Surgical procedures included in situ reconstruction of the aorta (n = 21) and extraanatomic bypass associated with aneurysmal resection (n = 4). In 19 patients, prostheses were covered with omental flaps, and antibiotics were continued for more than 6 weeks in all patients. In patients who underwent in situ reconstruction, three deaths were related to the initial surgery. All surviving patients were regularly followed up, and none showed any sign of late septic recurrence. In patients who underwent extraanatomic bypass, two died in the postoperative period, one underwent reoperation 2 years after the initial surgery, and the last patient is doing well. Positive postoperative blood cultures (n = 4) revealed persistent sepsis: two cholecystitis, one spondylitis, and one aortic infection. An exhaustive review of the literature was performed; clinical, bacteriologic, and operative features and results were analyzed; prognostic factors were evaluated; and a practical therapeutic approach was suggested. The importance of preoperative diagnosis, complete resection, debridement of infected tissues, omental flap coverage, and long-term antibiotic therapy with regular computerized tomographic scanning follow-up is stressed.