Surgical repair of descending thoracic and thoracoabdominal aortic aneurysms in patients with human immunodeficiency virus infection: a 10-patient series.

BACKGROUND: Major surgery in patients with human immunodeficiency virus (HIV) infection increases the risk of complications such as cardiovascular morbidity and opportunistic infections. METHODS: This study reports our experience with open surgical repair of 10 descending thoracic and thoracoabdominal aortic aneurysms in patients with HIV. RESULTS: Seven were men, and their median age was 49 years. All patients were controlled with highly active antiretroviral therapy (mean CD4+: 613/mm(3)). Three patients died (1 preoperatively, 1 after rupture, and 1 after elective surgery). No patient had spinal cord ischemia or infectious complications, either early or after a median follow-up of 29 months. Bacteriologic and histologic analyses did not determine any specific etiology for the aneurysms. CONCLUSIONS: Surgical repair of descending thoracic and thoracoabdominal aortic aneurysms in patients with HIV infection is feasible and may not lead to remote infectious complications.

[In situ arterial allografting for aortoiliac infection]. / Traitement des infections aorto-iliaques par allogreffe artérielle in situ.

From January 2009 to January 2013, we treated 83 patients for aortoiliac infection by resection of all infected material and in situ revascularization with an arterial allograft. Thirteen patients (15.7 %) died during the first month or before discharge. Perioperative mortality was associated with the presence of a visceral fistula: five deaths (27.8%) occurred among the 18 patients with a visceral fistula, and8 (12.3 %) among the 65 without a visceral fistula (p = 0.11). These results confirm those of our previous studies regarding the severity of aortoiliac infection, especially in patients with a visceral fistula, and endorse our in situ allografting strategy.