DIRECT REPLACEMENT OF MYCOTIC THORACOABDOMINAL ANEURYSMS

Direct graft replacement with local debridement and prolonged administ ration of antibiotics was used in the treatment of six patients with m ycotic thoracoabdominal aneurysms. The only early death occurred in a patient with systemic sepsis related to Staphylococcus aureus mycotic suprarenal aneurysm. Long-term survival of the remaining patients has been excellent: two patients died of unrelated causes at 5 and 6 years , respectively; one patient remains alive with known persistent infect ion at 5 years; and the remaining patients are alive with no evidence of infection at 11/2 and 10 years, respectively. Percutaneous aspirati on of infected perigraft fluid with local instillation of antibiotics along with administration of intravenous antibiotics may provide palli ation in selected patients with recurrent infections. In view of the m agnitude of the problems associated with recurrent infection, life-tim e administration of antibiotics is recommended after in situ graft rep lacement of mycotic thoracoabdominal aneurysms.