ABSTRACT
A 74-year-old man with pain and swelling of the left thigh was transferred from another hospital for further investigation. On admission, a diagnosis of a left femoral vein thrombosis was made and he continued on anticoagulant therapy. However, three and a half hours after admission he suddenly developed hypotensive shock and became unconscious. Rupture of a peripheral aneurysm was suspected in view of a rapid fall in the hematocrit and the images of vascular echography. Rupture of a left popliteal aneurysm was specifically diagnosed following intraarterial digital subtraction angiography. An emergency aneurysmectomy and vascular reconstruction using the great saphenous vein was performed. Interestingly, <i>Klebsiella pneumoniae</i> was cultured from both the wall of the left popliteal artery and the wound. Antibiotic therapy was therefore changed to flomoxef (FMOX) on the 5th postoperative day (POD 5) and treatment continued for a total of 6 weeks in accordance with the therapy of infectious endocarditis. He returned to the previous hospital on POD 61.
ABSTRACT
Infected abdominal aortic aneurysm is uncommon, but it has a grave prognosis. We report a case of infected abdominal aortic aneurysm with localized dissection that was preoperatively given antibiotics for 1 month, followed by an anatomical vascular reconstruction with a prosthetic graft wrapped with a pedicled omental flap. A 48-year-old man with uncontrolled diabetis mellitus was admitted with fever, appetite loss, and pulsating abdominal pain. Abdominal CT revealed a saccular aneurysmal change in the infrarenal aorta and weakly enhanced surrounding soft tissue density. Two lumens were clearly enhanced in the aneurysm. <i>Klebsiella pneumoniae</i> infection was diagnosed on the basis of blood culture. Pathologically, suppurative inflammation was confirmed in the surrounding tissue and dissection of the media of the saccular aneurysmal wall was indicated. After administration of antibiotics for 1 month, both clinical and laboratory indications of inflammatory reaction improved. The aneurysm was then almost completely resected and replaced with a Y-shaped prosthetic graft covered with a pedicled omental flap. The postoperative course was uneventful. After surgery, antibiotics were administered for 3 more months. The patient is now surviving and has no symptoms 6 months after operaion. Complete removal of the infected lesion and long-term follow-up with antibiotic chemotherapy are important for this situation.
ABSTRACT
To avoid homologous blood transfusion, the effectiveness of autologous blood predonation was evaluated in patients with elective abdominal aortic aneurysm (AAA) repair. From January 1993 to July 1996, 53 patients underwent Y graft replacement by using autologous rapid transfusion device AT1000<sup>®</sup> (Electromedics. Inc, Englewood, CO). The patients were devided in to 3 groups. Thirty one patients had no blood donation (Group A). Twelve patients had 400ml blood donation with administration of an iron preparation (Group B). Ten patients donated the same amount of blood as those in Group B, with administration of both an iron preparation and recombinant human erythropoietin (rHuEPO) (Group C). There were no significant differences in terms of age, gender, operating time, intraoperative bleeding, and total amount of homologous and autologous blood transfusion in the 3 groups. In Group A, the mean volume of homologous blood transfusion was 250±370ml and in both Groups B and C, no homologous blood was required and 400ml autologous blood was used. Homologous blood transfusion was avoided in 58.9 (18/31) of patients in Group A and all of the patients in Groups B and C. Due to the blood predonation prior to surgery, a hemoglobin level decreased significantly at the time of operation in Group B (without rHuEPO), but in Group C (with rHuEPO) the hemoglobin level was kept constant. During the first postoperative week, the minimum hemoglobin level in Group C was significantly higher than in the other groups. In conclusion, by donating 400ml autologous blood before surgery and using an intraoperative autotransfusion system, homologous blood transfusion could be avoided in elective AAA repair. With rHuEPO, the hemoglobin level could be maintained, despite predonation and intraoperative blood loss.