Background Mortality in patients with infected aortic aneurysms remains high. A number of patient- and infection-specific risk factors for death have been proposed, but none is consistently predictive of poor outcomes. The purpose of this study was to examine the possible contribution of infection-related risk factors and the systemic inflammatory response syndrome (SIRS) to outcomes of patients with infected aortic aneurysms. Study design Ten patients with infected aortic aneurysms presenting to our institution over a recent 6-year period were studied. Collected data included aneurysm location, culture results, preoperative indicators of SIRS, operative details, and outcomes. Results Common presenting symptoms included abdominal or back pain and fevers. Aneurysms involved the thoracoabdominal aorta in four patients, the suprarenal aorta in one, the juxtarenal aorta in one, and the infrarenal aorta in four. Seven patients met criteria for SIRS. Repairs included in situ replacement of the infected aneurysm using rifampin-soaked, gel-impregnated Dacron in four patients with thoracoabdominal aneurysms and using autogenous superficial femoral-popliteal vein in five patients with infrarenal aneurysms. Four patients died of sepsis, and six patients survived to discharge after a mean of 23 ± 12 days in the hospital, followed by extensive rehabilitation. The combination of SIRS and suprarenal extension was present in all four patients who died. Conclusions Although rare, infected aortic aneurysms are associated with marked morbidity and mortality. Sepsis is the leading cause of death. A combination of host- and infection-specific variables may be more predictive of outcomes than any single risk factor. Prolonged hospitalization and extended rehabilitation are frequently required in survivors, but longterm outlook is good after successful treatment.

https://www.journalacs.org/article/S1072-7515(02)01607-1/pdf

Surgical mortality in patients with infected aortic aneurysms

Background : Mycotic aneurysms are rare. Conventional surgical options include ligation or excision with in-situ or extra-anatomical reconstruction. The use of endoluminal stenting for mycotic aneurysms in the presence of sepsis is controversial, but may be a temporising measure, or sometimes the only option in the management of critically ill patients who are not fit for surgery.Methods : A literature review was undertaken using Medline, all relevant papers on endoluminal management of mycotic aneurysm were taken into account.Results : Open surgical repair of mycotic aortic aneurysm is associated with considerable peri-and post-operative morbidity and mortality. Endoluminal treatment with stent-grafts has been introduced as an alternative, and early results are promising.Conclusion : No level I evidence for the endoluminal treatment of mycotic aneurysms exists. Ideally a randomised controlled trial of open surgery versus endoluminal treatment should be performed but this may be difficult to perfo...

The management of mycotic aortic aneurysms: is there a role for endoluminal treatment?

We evaluated the impact f standard cryopreservation on mechanical and functional properties of human aortic homografts. From 14 human heart-valve donors, the thoracic descending aorta was obtained. Effects of cryopreservation on mechanical (elastic properties and breaking stress) and smooth muscle cell (SMC) and endothelium function were tested. Cryopreservation (cryo) did not significantly affect Young's modulus of elastin (fresh: 3.1 ± 1.0, cryo: 2.7 ± 0.9 × 105 Nm–2), collagen recruitment pressure (fresh: 1.1 ± 0.3, cryo: 1.1 ± 0.4 × 104 Nm–2), distensibility (fresh: 3.8 ± 1.8, cryo: 3.6 ± 1.6 × 105 N–1m2), or breaking stress (fresh: 2.4 ± 1.0, cryo: 2.2 ± 1.0 × 106 Nm–2). Following explantation, no endothelium-dependent relaxation was found. SMC function and endothelium-independent relaxation were mainly intact after explantation but significantly decreased after cryopreservation. Aortic mechanical properties are not influenced by cryopreservation. Following explantation, almost no endothelial cell function is present, and SMC contractility is strongly affected after cryopreservation.

Impact of current cryopreservation procedures on mechanical and functional properties of human aortic homografts

In situ replacement with equine pericardial roll grafts for ruptured infected aneurysms of the abdominal aorta.

Multiple Mycotic Aortic Aneurysms due to Streptococcus pneumoniae

Infected aortic aneurysms are a rare (1.3% of all abdominal aortic aneurysms) but life-threatening disease. At present controversy continues about the specific diagnosis and the best surgical management. We present one case of infected aortic aneurysm treated with in situ reconstruction with cryopreserved arterial homograft. He was a 50-year-old man with recent history of pneumococcal meningitis who is readmitted because he suffered a stroke and during physical examination a pulsatile abdominal mass was discovered. Blood cultures were done and the result was repeatedly negative. Radiological studies were performed: the abdominal CT scanning showed a non ruptured 5 cm infrarenal aortic aneurysm with irregular wall and in the aortography it appeared eccentric, multilobulated with a clear neck in an otherwise normal size aorta but with some arteriosclerotic lesions. The diagnosis of infected aneurysm was suspected and the patient received antibiotic therapy and was operated on: aneurysm resection with wide debridement of surrounding tissues and in situ aortic replacement with aortobifemoral cryopreserved arterial homograft. Cultures of the aneurysm wall and contents were negative but aneurysm wall biopsy suggested an infected aortic aneurysm. The postoperative course was uneventful and antibiotics were continued for 6 weeks. The patient is doing well 7 months after surgery without signs of recurrent infection and normal appearance of the cryopreserved arterial homograft. We conclude that specific diagnosis of infected aortic aneurysms is essential for correct treatment but may be difficult, in these cases a history of infection supported by radiologic findings and aneurysm wall biopsy are of great value. Cryopreserved arterial homografts constitute a good alternative to prosthetic grafts for in situ reconstructions in the treatment of infected aortic aneurysms, decreasing the risk of re-infection or septic complications.

Infected abdominal aortic aneurysm: in situ replacement with cryopreserved arterial homograft.

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Infected abdominal aortic aneurysm: in situ replacement with cryopreserved arterial homograft.