title: Single-center experience with open surgical treatment of 36 infected aneurysms of the thoracic, thoracoabdominal, and abdominal aorta.
abstract: BACKGROUND
  To describe a single-center experience with open surgical treatment of infected aortic aneurysms. We analyzed risk factors for 90-day mortality.
  
  
  METHODS
  Between 1983 and 2008, 4,410 patients underwent open surgery for thoracic, thoracoabdominal, or abdominal aneurysm at our institution. Primary infection of the aneurysm was suspected because of clinical signs of infection in combination with typical radiological and morphological aspects in 66 patients (1.5%). In all, 36 patients displayed 10 different kinds of organisms in cultures of blood and/or intraoperative specimens and were further analyzed.
  
  
  RESULTS
  The group consisted of 23 men and 13 women, with a mean age of 66.8 ± 8 (50-84) years. Location of the aneurysm was thoracic in five patients (14%), thoracoabdominal in 13 patients (36%), and abdominal in 18 patients (50%). Eleven patients (28%) were treated before and 25 (72%) after 1995. We found free rupture in three cases; contained rupture into surrounding tissue in 23 cases (64%); penetration into lung, bronchus, esophagus, or inferior vena cava in five cases; and an intact aneurysm in another five cases. Kinds of surgery were as follows: extra-anatomic revascularization in four patients (11%), Dacron patch plasty in four patients (11%), in situ revascularization in 24 patients (66%), and four patients died during surgery before reconstruction (11%). In all, 13 patients died during hospital stay (36%). In 25 patients treated after 1995, 90-day mortality was 24% and was significantly better (p < 0.05) than the rate of 64% in 11 patients treated before 1995. Outcome depended on status of rupture: all patients with free rupture, three of five patients (60%) with rupture into an organ, seven of 23 patients (30%) with contained rupture into the surrounding tissue, but no patient with intact aneurysm died. Age, gender, bacterium, location of the aneurysm, and method of surgical treatment did not influence 90-day mortality. During follow-up, 18 patients died after a mean of 56 ± 49 months. One patient died because of an infected aortic prosthesis.
  
  
  CONCLUSIONS
  Outcome of patients with infected aortic aneurysms has improved during the last 15 years and depends on the status of rupture at time of surgery. Therefore, only early diagnosis and early treatment can further improve the prognosis.
authors.affiliation: Clinic for Vascular Surgery and Kidney Transplantation, University Hospital of Düsseldorf, Heinrich-Heine-University of Düsseldorf, Moorenstr, 5 Düsseldorf, North Rhine-Westphalia, Germany. weis.mueller@arcor.de
authors.forename: Barbara Theresia
authors.initials: BT
authors.lastname: Weis-Müller
authors.forename: Claudio
authors.initials: C
authors.lastname: Rascanu
authors.forename: Atilla
authors.initials: A
authors.lastname: Sagban
authors.forename: Klaus
authors.initials: K
authors.lastname: Grabitz
authors.forename: Erhard
authors.initials: E
authors.lastname: Godehardt
authors.forename: Wilhelm
authors.initials: W
authors.lastname: Sandmann
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000785:Aneurysm, Infected / Q000000981:diagnostic imaging / Q000382:microbiology / Q000401:mortality / Q000601:surgery*; D017544:Aortic Aneurysm, Abdominal / Q000000981:diagnostic imaging / Q000382:microbiology / Q000401:mortality / Q000601:surgery*; D017545:Aortic Aneurysm, Thoracic / Q000000981:diagnostic imaging / Q000382:microbiology / Q000401:mortality / Q000601:surgery*; D001019:Aortic Rupture / Q000382:microbiology / Q000401:mortality / Q000601:surgery*; D001027:Aortography / Q000379:methods; D016009:Chi-Square Distribution; D005260:Female; D005858:Germany; D017052:Hospital Mortality; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D014656:Vascular Surgical Procedures / Q000009:adverse effects / Q000401:mortality