In situ polytetrafluoroethylene graft bypass for primary infected aneurysm of the infrarenal abdominal aorta.
BACKGROUND
Reinfection is a major issue of surgical treatment for patients with infected abdominal aortic aneurysm (AAA). The present report describes outcomes after use of our procedure for treating patients with infected aneurysm of the infrarenal abdominal aorta. The procedure involved an in situ polytetrafluoroethylene (PTFE) graft bypass and omental wrapping of the graft. The procedure was used regardless of the presence of Gram-stain-positive pus or tissue or the type of pathogen identified.


METHODS
We retrospectively reviewed nine consecutive patients with primary infected aneurysms of the infrarenal abdominal aorta treated from June 2001 to August 2006 at the Asan Medical Center, Seoul, Korea. Diagnosis was based on preoperative abdominopelvic CT scans. Treatment involved removal of all infected tissue, including infected aorta tissue, in situ PTFE graft reconstruction, and wrapping of the graft with retrocolically transposed great omentum. Sensitive antibiotics were administered before and after the operation.


RESULTS
In all cases, aneurysms were the result of aortitis and aortic wall perforation, and presented as aortic pseudoaneurysms with rupture. The pathogens identified were Salmonella non-typhi (n = 4), Klebsiella pneumoniae (n = 2), Streptococcus pneumoniae (n = 1), Citrobacter freundii (n = 1), and Brucella abortus (n = 1). There was no infection-related morbidity or mortality during a median follow-up period of 49 months.


CONCLUSIONS
Surgical treatment comprising complete removal of all infected tissue, in situ PTFE graft reconstruction, and omental wrapping of the graft was effective in treating infected AAA. Key adjunct procedures were a precise preoperative diagnosis using abdominopelvic CT scans, and pre- and postoperative sensitive antibiotic treatment.
Division of Vascular Surgery, Department of Surgery, University of Ulsan College of Medicine and Asan Medical Center, 388-1 Pungnap-2dong, Sonpa-gu, Seoul, 138-736, Korea. twkwon2@amc.seoul.kr
Tae-Won
TW
Kwon
Hyang-Kyoung
HK
Kim
Ki-Myung
KM
Moon
Yong-Pil
YP
Cho
Sang-Jun
SJ
Park
D000038:Abscess / Q000473:pathology; D000368:Aged; D000785:Aneurysm, Infected / Q000453:epidemiology / Q000601:surgery*; D017544:Aortic Aneurysm, Abdominal / Q000453:epidemiology / Q000601:surgery*; D001025:Aortitis / Q000150:complications; D016470:Bacteremia / Q000453:epidemiology; D019917:Blood Vessel Prosthesis Implantation / Q000379:methods; D015897:Comorbidity; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011138:Polytetrafluoroethylene; D012189:Retrospective Studies; D012307:Risk Factors; D014057:Tomography, X-Ray Computed
D011138:Polytetrafluoroethylene