IN-SITU PROSTHETIC GRAFT REPLACEMENT FOR MYCOTIC THORACOABDOMINAL ANEURYSMS

Infected aortic aneurysms remain a difficult surgical problem associat ed with high morbidity and mortality. We report three cases of mycotic thoracoabdominal aneurysms treated by debridement of infected aortic tissue, in situ prosthetic graft replacement, and intensive antibiotic therapy. One early death occurred in a patient with systemic sepsis r elated to Salmonella enteritidis infection of the thoracic aorta secon dary to a colovesical fistula. The two other patients remain alive at 2 years without further complications of the surgery. Bacteriology is as follows: Staphylococcus aureus, Streptococcuss pneumoniae, and Salm onella enteritidis. In all patients the operation was performed immedi ately after the diagnosis was confirmed. Antibiotic therapy was begun intraoperatively and was continued for at least 6 months. Two patients were followed regularly, and there have been no septic recurrences in our 2-year follow-up period. In situ prosthetic graft replacement in conjunction with intensive antibiotic therapy is a viable option in th e treatment of mycotic thoracoabdominal aortic aneurysms.