Selective medical treatment of infected aneurysms of the aorta in high risk patients.
BACKGROUND
Infected aneurysm of the aorta is almost always fatal without undergoing aortic resection. Medical treatment was attempted selectively in patients who were considered too high risk for surgery. We review our experience with 22 patients treated without undergoing aortic resection over 12 years.


METHODS
Retrospective chart review.


RESULTS
Between 1995 and 2007, 22 cases of infected aortic aneurysms treated without undergoing aortic resection during the first admission were included. There were 17 men with a median age of 76 years (range, 35 to 88 years). Of 18 pathogens isolated, the most common responsible microorganism was nontyphoid Salmonella in 11 followed by Staphylococcus aureus in five. The site of infection was thoracic in eight and abdominal in 14. The hospital mortality rate was 50%, and the aneurysm-related mortality rate after long-term follow-up was 59%. The event-free survival rate at one year was 32%. Of 11 patients with Salmonella infection, eight patients have lived beyond 30 days and six were event-free after one year. Of 11 patients with non-Salmonella, four patients have lived beyond 30 days and only one was event-free after one year. The overall aneurysm-related mortality rate was 36% in Salmonella infected patients and 82% in non-Salmonella infected patients.


CONCLUSIONS
Clinical results of medical treatment using current antibiotics in patients with infected aortic aneurysm were poor. Traditional surgical excision of infected aortic aneurysms with revascularization remains the gold standard and should be attempted except in high risk patients.
Department of Surgery, National Taiwan University Hospital, National Taiwan University College of Medicine, Taiwan, Republic of China.
Ron-Bin
RB
Hsu
Chung-I
CI
Chang
I-Hui
IH
Wu
Fang-Yue
FY
Lin
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000785:Aneurysm, Infected / Q000188:drug therapy* / Q000382:microbiology / Q000401:mortality / Q000601:surgery; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D001014:Aortic Aneurysm / Q000188:drug therapy* / Q000382:microbiology / Q000401:mortality / Q000601:surgery; D018572:Disease-Free Survival; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D012189:Retrospective Studies; D018570:Risk Assessment; D013997:Time Factors; D016896:Treatment Outcome; D014656:Vascular Surgical Procedures / Q000009:adverse effects*
D000900:Anti-Bacterial Agents