Cs. Cina et al., Ruptured mycotic thoracoabdominal aortic aneurysms: A report of three cases and a systematic review, J VASC SURG, 33(4), 2001, pp. 861-867
Citations number
50
Categorie Soggetti
Cardiovascular & Respiratory Systems","Cardiovascular & Hematology Research
We report three cases of ruptured mycotic thoracoabdominal aortic aneurysms
(TAAAs) and a review of the literature. Escherichia coli and Streptococcus
pneumoniae (2 patients) were the responsible organisms. Surgical managemen
t consisted of wide debridement of necrotic tissue and in situ repair with
a Dacron graft. Antibiotics were administered intravenously in the hospital
and continued orally after discharge for at least 6 weeks, until clinical
and laboratory parameters were normalized. A review of the literature showe
d that Gram-negative microorganisms are found in 47% of mycotic TAAAs. A tr
end toward increased mortality for these organisms, compared with Gram-posi
tive microorganisms, was observed (P = .09). Lifelong antimicrobial therapy
is controversial. No difference in survival or recurrence rate was found b
etween series advocating lifelong therapy and those suggesting prolonged (6
weeks to 12 months) therapy (median follow-up period, 18 and 19 months, re
spectively). In situ repair with synthetic material can be successful if pr
ompt confirmation of infection is obtained, all possibly infected tissue is
resected, and antibiotic therapy based on sensitivity data is administered
for a prolonged period. A short-term survival rate as high as 82% can be e
xpected with this strategy, but data on long-term survival rates are limite
d. Polytetrafluoroethylene-expanded grafts, homografts, and antibiotic-bond
ed grafts may offer advantages over Dacron grafts, but data are insufficien
t to draw conclusions. Careful long-term follow-up is an important element
of the treatment of these patients. We suggest antibiotic treatment until b
iochemical parameters of inflammation (white cell count, erythrocyte sedime
ntation rate, or C-reactive protein) return to normal and a computerized to
mography scan every 3 months for 1 year, then annually.