Vasc Spec Int.  2015 Jun;31(2):41-46. 10.5758/vsi.2015.31.2.41.

Surgical Treatment of Infected Aortoiliac Aneurysm

• Youn JK
• Kim SM
• Han A
• Choi C
• Min SI
• Ha J
• Kim SJ
• Min SK

• KMID: 2049884
• DOI: http://doi.org/10.5758/vsi.2015.31.2.41

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.

Keyword

Infected aneurysm; Operation; Endovascular procedure; Bypass; Mycobacterium

MeSH Terms

Aneurysm*
Aneurysm, Infected
Aorta
Aorta, Abdominal
Debridement
Electronic Health Records
Endovascular Procedures
Follow-Up Studies
Hospital Mortality
Humans
Iliac Artery
Klebsiella
Mycobacterium
Retrospective Studies
Rupture
Salmonella
Seoul
Sepsis
Staphylococcal Infections
Staphylococcus
Stents
Suppuration
Transplants
Tuberculosis