Surgical Treatment of the Infected Arterial Aneurysms / 日本心臓血管外科学会雑誌

ABSTRACT

The infected arterial aneurysm has a fulminent infectious process frequently resulting in death if not properly treated. We reviewed 10 patients to identify the aneurysm location, etiology, bacteriology, and the mortality of surgical treatment. The abdominal and thoracic aorta was the most common site (6 cases). The primary causes were infected endocarditis, acute cholecystitis, abscess in the psoas muscle and depressed immunocompetence, but there was no case of iatrogenic trauma. Eight patients had positive blood or aneurysmal wall culture, <i>Staphylococcus aureus, Staphylococcus epidermidis</i> and salmonella being the most frequent bacteria identified. The proper treatment of infected arterial aneurysm remains controversial. Three methods of surgical treatment were performed; one, <i>en bloc</i> aneurysmal excision with <i>in situ</i> prosthetic graft replacement, two, open aneurysmal resection and irrigation with large amount of diluted popdon iodine solution followed by <i>in situ</i> prosthetic graft replacement with wrapping by an omental pedicle. Three, extraanatomical bypass grafting. Six of 7 patients in whom the infection subsided with antibiotic therapy showed good long term results. However, 3 patients with uncontrollable infection died 1 to 3 months after operation.