Infected aneurysm of the thoracic aorta.
BACKGROUND
Infected aneurysm of the thoracic aorta is rare and can be fatal without surgical treatment. We review our experience with 32 patients during a 12-year period.


METHODS
Retrospective chart review.


RESULTS
Between 1995 and 2007, 32 patients (24 men, 8 women) with infected aneurysms of thoracic aorta were treated at our hospital. Their median age was 74 years (range, 50-88 years). Of the 28 pathogens isolated, the most common responsible microorganism was nontyphoid Salmonella in 16 (57%), followed by Staphylococcus aureus in four (14%) and Mycobacterium tuberculosis in three (11%). The site of infection was the aortic arch in 13 patients, proximal descending thoracic aorta in 10, and distal descending thoracic aorta in 9. Seven patients had medical treatment alone, and 25 patients underwent in situ graft replacement. The hospital mortality rate of medical treatment alone was 57%, and the hospital mortality rate of in situ grafting was 12%. Of the 22 operated-on survivors, there were 11 late deaths, four of which were aneurysm-related. The aneurysm-related mortality rate in operated-on patients was 28%. Of 16 patients with infection caused by nontyphoid Salmonella, 13 patients underwent in situ grafting, with a hospital mortality rate of 8% and aneurysm-related mortality rate of 31%.


CONCLUSIONS
Infected aneurysm of the thoracic aorta was uncommon. The clinical results of in situ grafting were improving. Nontyphoid Salmonella was the most common responsible microorganism, and the prognosis of infection caused by Salmonella was not dismal. Outcomes of other management strategies, such as endovascular stenting, need to be compared with these results.
Hsu
Ron-Bin
RB
Department of Surgery, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan, Republic of China.
Lin
Fang-Yue
FY
D000368:Aged; D000369:Aged, 80 and over; D000785:Aneurysm, Infected / Q000188:drug therapy / Q000382:microbiology / Q000401:mortality / Q000601:surgery / Q000628:therapy*; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D017545:Aortic Aneurysm, Thoracic / Q000188:drug therapy / Q000382:microbiology / Q000401:mortality / Q000601:surgery / Q000628:therapy*; D019917:Blood Vessel Prosthesis Implantation; D003646:Debridement; D005260:Female; D005500:Follow-Up Studies; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D012107:Research Design; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome
D000900:Anti-Bacterial Agents