Infected aortic aneurysms: Aggressive presentation, complicated early outcome, but durable results

Objective: Infected aortic aneurysms are rare, difficult to treat, and asso ciated with significant morbidity. The purpose of this study was to review the management and results of patients with infected aortic aneurysms and i dentify clinical variables associated with poor outcome. Methods. The clinical data and early and late outcomes of 43 patients treat ed for infected aortic aneurysms during a 25-year period (1976-2000) were r eviewed. Variables were correlated with risk of aneurysm-related death and vascular complications, defined as organ or limb ischemia, graft infection or occlusion, and anastomotic or recurrent aneurysm. Results: Infected aneurysms were infrarenal in only 40% of cases. Seventy p ercent of patients were immunocompromised hosts. Ninety-three percent had s ymptoms, and 53% had ruptured aneurysms. Surgical treatment was in situ aor tic grafting (35) and extra-anatomic bypass (6). Operative mortality was 21 % (9/42). Early vascular complications included ischemic colitis (3), anast omotic disruption (1), peripheral embolism (1), paraplegia (1), and monopar esis (1). Late vascular complications included graft infection (2), recurre nt aneurysm (2), limb ischemia (1), and limb occlusion (1). Mean follow-up was 4.3 years. Cumulative survival rates at 1 year and 5 years were 82% and 50%, respectively, significantly lower than survival rates for the general population (96% and 81%) and for the non-infected aortic aneurysm cohort ( 91% and 69%) at same intervals. Rate of survival free of late graft-related complications was 90% at 1 year and 5 years, similar to that reported for patients who had repair of noninfected abdominal aortic aneurysms (97% and 92%). Variables associated with increased risk of aneurysm-related death in cluded extensive periaortic infection, female sex, Staphylococcus aureus in fection, aneurysm rupture, and suprarenal aneurysm location (P < .05). For risk of vascular complications, extensive periaortic infection, female sex, leukocytosis, and hemodynamic instability were positively associated (P < .05). Conclusion: Infected aortic aneurysms have an aggressive presentation and a complicated early outcome. However, late outcome is surprisingly favorable , with no aneurysm-related deaths and a low graft-related complication rate , similar to standard aneurysm repair. In situ aortic grafting is a safe an d durable option in most patients.