Abstract
Purpose
The purpose of this study was to analyze the surgical procedures, culture results, and outcomes, and to survey the prevalence of the infectious organisms over a 30-year period in patients with a primary infected abdominal aortic aneurysm (PIAAA).
Methods
A total of 11 patients (1.8%) with PIAAA were surgically treated between 1982 and June 2009. All patients had back pain, leukocytosis, and elevated C-reactive protein level. All of the patients underwent either urgent or emergency operations.
Results
Cultures of aortic wall specimens and blood were positive in 10 patients and included Salmonella in 2, Streptococcus in 2, Campylobacter fetus in 2, and Listeria, Haemophilus influenzae, Serratia marcescens, Bacteroides thetaiotaomicron, and an unknown organism in 1 patient each. The 10 patients underwent in situ prosthetic grafting with excision of the infected tissue and lavage using 10 l saline solution; omentum plasty was required in four patients. An axillofemoral bypass was performed in one patient with pus surrounding the AAA. All 10 patients with in situ replacement survived and were administered intravenous antibiotic therapy for 1 month postoperatively. All of these patients left the hospital without any further complications. However, one patient who underwent an axillofemoral bypass died of overwhelming sepsis.
Conclusion
In situ replacement with excision of infected tissue, lavage using 10 l saline solution, and omentum plasty for PIAAA successfully resolved the condition. High local concentrations of rifampin-soaked grafts or superficial femoral vein may also be an alternative for an in situ replacement conduit.
Similar content being viewed by others
References
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.
Mueller BT, Wegener OR, Geabitz K, Pillny M, Thomas L, Sadmann W. Mycotic aneurysms of the thoracic and abdominal aorta and iliac arteries: experience with anatomic and extraanatomic repair in 33 cases. J Vasc Surg 2001;33:106–113.
Hsu RB, Tsay YG, Wang SS, Chu SH. Surgical treatment for primary infected aneurysm of the descending thoracic aorta, abdominal aorta, and iliac arteries. J Vasc Surg 2002;36:746–750.
Fillmore AJ, Valentine RJ. Surgical mortality in patients with infected aortic aneurysm. J Am Coll Surg 2003;196:435–441.
Macedo TA, Stanson AW, Oderich GS, Johnson CM, Panneton JM, Tie ML. Infected aortic aneurysms: imaging findings. Radiology 2004;231(1):250–251.
Sezai A, Negichi N, Niino S, Maeda H, Ichiwada M, Suzuki K, et al. In situ reconstruction for infected abdominal aortic aneurysm. Jpn J Vasc Surg 1994;3:371–379.
Uno M, Yamada N, Yamada I, Nagano I, Kagimoto K, Kanazawa H. A case of infected abdominal aortic aneurysm. J Jpn Surg Assoc 2006;67(8):1763–1767.
Toya N, Toriumi H, Sumi M, Kurosawa K, Negishi Y, Ishii Y, et al. In situ prosthetic graft replacement for infected abdominal aortic aneurysms. Jpn J Vasc Surg 2004;13:585–589.
Hachimaru T, Watanabe M, Kawaguchi S, Nakahara H. In situ replacement with rifampicin-soaked vascular prosthesis in a patient with abdominal aortic aneurysm infected by Listeria monocytogenes and presenting with symptoms of Leriche syndrome. Jpn J Cardiovasc Surg 2009;38:344–348.
Hananda T, Higami T, Inao T. A case of infected abdominal aortic aneurysm observed its formation course on CT. J Jpn Surg Assoc 2005;66(9):2125–2128.
Kunishige H, Yasuda K. Extra-anatomic bypass grafting for infected abdominal aortic aneurysm with pyogenic spondylitis — a case report. J Jpn Surg Assoc 2005;66(2):346–349.
Hirotaka G, Izumiyama O. A case of infected abdominal aortic aneurysms. J Jpn Surg Assoc 2004;65(5):1205–1208.
Akiyama T, Matsubara K. Tuberculous mycotic pseudoaneurysm of abdominal aorta. Jpn j Cardiovasc Surg 2008;37:174–176.
Hasegawa M, Hanzawa Y. A case of infected abdominal aortic aneurysm combined with inferior vena cava thrombosis. J Jpn Surg Assoc 2009;70(2):403–406.
Skandalos I, Christou K, Psilas A, Moskophidis M, Karamoschos K. Mycotic abdominal aortic aneurysm infected by Vibrio mimicus: report of a case. Surg Today 2009;39(2):141–143.
Hachimaru T, Watanabe M, Nakahara H. Impending rupture of an infected thoracoabdominal aortic aneurysm — a case report. J Jpn Surg Assoc 2008;69(9):2202–2206.
Bito A, Nakahara Y, Murata N, Yamamoto N. A case of infected thoracoabdominal aortic aneurysm caused by Citrobacter koseri. Jpn J Cardiovasc Surg 2008;37(6):333–336.
Sakamoto K, Hayashi Y, Taki T, Nishizawa J, Nakayama S. Infected abdominal aortic aneurysm rupture due to Listeria monocytogenes. Jpn J Cardiovasc Surg 2008;37(4):226–229.
Oudot J, Beaconsfield P. Thrombosis of the aortic bifurcation treated by resection and homograft replacement. Arch Surg 1953;66:365–374.
Dubost C, Allary M, Oeconomos N. Resection of an aneurysm of the abdominal aorta: reestablishment of the continuity by a preserved human arterial graft, with result after five months. Arch Surg 1952;64:405–408.
DeBakey ME, Cooley DA. Surgical treatment of aneurysm of abdominal aorta by resection and restoration of continuity with homograft. Surg Gynecol Obstet 1953;97:257–266.
Brock RC. Discussion on reconstructive arterial surgery. Proc R Soc Med 1953;46:115–130.
Smith RB III. President’s address: the foundations of modern aortic surgery. J Vasc Surg 1998;27:7–15.
Zou W, Lin PH, Bush RL, Terramani TT, Matuura JH, Cox M, et al. In situ reconstruction with cryopreserved arterial allografts for management of mycotic aneurysms or aortic prosthetic graft infections. Tex Heart Inst J 2006;33(1):14–18.
Kazuno K, Ogino H, Matsuda H, Minatoya K, Sasaki H, Kitamura S. Repair of an infected aortic aneurysm using an aortic allograft and a venous autograft: report of a case. Surg Today 2008;38:948–950.
Clagett GP, Valentine RJ, Hagino RT. Autogenous aortoiliac/femoral reconstruction from superficial-femoral popliteal veins: feasibility and durability. J Vasc Surg 1007;25:255–270.
Nevelsteen A, Lacroix H, Suy R. Autogenous reconstruction with the lower extremity deep veins: an alternative treatment of prosthetic infection after reconstructive surgery for aortoiliac disease. J Vasc Surg 1995;22:129–134.
Yao JDC, Moellering RC Jr. Antibacterial agents, in antimicrobial agents and susceptibility testing. In: Murray PR, et al, editors. Manual of clinical microbiology. 7th ed. Washington, DC: ASM Press; 1999. p. 1474–1504.
Vicaretti M, Hawthorne W, Ao PY, Fletcher JP. Doses in situ replacement of a staphylococcal-infected vascular graft with a rifampicin impregnated gelatin-sealed Dacron graft reduced the incidence of subsequent infection? Int Angiol 1999;18:225–232.
Koshiko S, Sasajima T, Muraki S, Azuma N, Yamazaki K, Chiba K, et al. Limitations in the use of rifampicin-gelatin grafts against virulent organisms. J Vasc Surg 2002;35:482–486.
Javerliat I, Goeau-Brisonniere O, Sivadon-Tardy V, Coggia M, Gaillard J-L. Prevention of Staphylococcus aureus graft infection by a new gelatin-sealed vascular graft prebonded with antibiotics. J Vasc Surg 2007;46:1026–1031.
Batt M, Magne J-L, Alric P, Muzj A, Ruotolo C, Ljungstrom K-G, et al. In situ revascularization with silver-coated polyester grafts to treat aortic infection: Early and midterm results. J Vasc Surg 2003;38:983–989.
Hardman S, Cope A, Swann A, Bell PRF, Naylor AR, Hayes PD. An in vitro model to compare the antimicrobial activity of silvercoated versus rifampicin-soaked vascular grafts. Ann Vasc Surg 2004;18:308–313.
Goeau-Brisonniere O, Fabre D, Leflon-Guibout V, Di Centa I, Nicolas-Chanoine M. Comparison of the resistance to infection of rifampin-bonded gelatin-sealed and silver / collagen-coated polyester prosthesis. J Vasc Surg 2002;35:1260–1263.
Kan CD, Lee HL, Yang YJ. Outcome after endovascular stent graft treatment for mycotic aortic aneurysm: A systematic review. J Vasc Surg 2007;46:906–912.
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Maeda, H., Umezawa, H., Goshima, M. et al. Primary infected abdominal aortic aneurysm: Surgical procedures, early mortality rates, and a survey of the prevalence of infectious organisms over a 30-year period. Surg Today 41, 346–351 (2011). https://doi.org/10.1007/s00595-010-4279-z
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00595-010-4279-z