[Bacterial aortitis].
A cohort of 14 patients with bacterial destruction of various segments of the aortic wall is presented. The Salmonella enteritidis strain was predominantly responsible. Most patients had typical history of symptomatic trias of sepsis, abdominal and/or back pain and positive blood cultures. CT scan showed pseudoaneurysm within the thoracic, subphrenic or subrenal aorta as well as acute hemorrhage in three patients. One of these was excluded from invasive treatment due to hopeless prognosis. In one patient primary aortoduodenal phistula was responsible for GI bleeding. Five patients were operated and prosthetic replacement of subrenal or iuxtarenal aortic portion together with aortorenal bypass in a couple of cases was performed. In eight patients stentgrafts (SG) of various types were deployed completed with femorofemoral crossover bypass when necessary. All patients were subject to long-standing antibiotic therapy. Two patients expired following SG insertion, all operated patients survived. Average follow-up has been 1 year (1-22 months) so far. A groin abscess was later drained in one patient. Neither CT nor isotope scanning showed persistent or recurrent infectious or hemorrhagic foci in any survivors whatsoever. The authors review and consider the doubtful indication of aortic SG deployment into the septic terrain in selected cases. Midterm results might justify its use in overly debilitated patients otherwise not eligible for radical operation due to its prohibitive risk.
Sebesta
P
P
Oddĕlení cévní chirurgie Nemocnice Na Homolce, Praha. pavel.sebesta@homolka.cz
Klika
T
T
Mach
T
T
Sedivý
P
P
Czinner
P
P
Zdráhal
P
P
Korisková
Z
Z
Michálek
P
P
Vitásek
P
P
Jindrák
V
V
Marek
J
J
D000368:Aged; D000369:Aged, 80 and over; D001025:Aortitis / Q000175:diagnosis / Q000382:microbiology* / Q000628:therapy; D001424:Bacterial Infections / Q000175:diagnosis / Q000628:therapy; D019917:Blood Vessel Prosthesis Implantation; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015607:Stents