title: Endovascular therapy for infected aortic aneurysms.
abstract: OBJECTIVE
  To determine the outcome of endovascular therapy for an infected aortic aneurysm in patients with or without aorto-aerodigestive/aortocaval fistulas.
  
  
  METHODS
  From September 2005 to May 2010, 21 patients, 17 abdominal and four thoracic infected aortic aneurysms were treated with an endovascular stent graft at Songklanagarind Hospital, Thailand. Five patients presented with fistula complications, 1 aortoesophageal, 1 aortobronchial, 1 aortocaval, and 2 aortoenteric fistulas. Lifelong antibiotics were planned for all patients. In-hospital mortality and follow-up outcomes were examined.
  
  
  RESULTS
  The average age was 66 years (range, 42-84) and 18 patients were male. All five cases in the fistulous group presented with symptoms related to the organs involved, four massive bleedings and one congestive heart failure. Symptoms of patients in the nonfistulous group were abdominal, back, or chest pain in 94%, fever in 81%, and diarrhea in 19%. Blood culture was positive in 10 patients (48%): eight Salmonella spp and two Burkholderia pseudomallei. The overall in-hospital mortality was 19% (4/21): 60% (3/5) in the fistula group and only 6% (1/16) in the nonfistula group. One conversion to open repair was performed in the fistula group 2 weeks after the endovascular procedure. During the follow-up period, one of the two survivors in the fistula group died at 18 months from unrelated causes, while there were no deaths in the 15 patients of the nonfistula group with an average patient follow-up of 22 months (range, 1-54). Periaortic inflammation and aneurysms in the nonfistula group completely disappeared in 10 of the 15 patients (67%). The aneurysm significantly shrunk in four patients (27%), and was stable at 1 month in one patient. There were no late conversions.
  
  
  CONCLUSIONS
  Endovascular therapy, as a definite treatment for infected aortic aneurysms, provided excellent short- and medium-term results in patients without fistula complications. However, a poorer outcome was evident in patients with fistula complications.
authors.affiliation: Department of Surgery, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, Thailand. kboonpra@medicine.psu.ac.th
authors.forename: Boonprasit
authors.initials: B
authors.lastname: Kritpracha
authors.forename: Dhanakom
authors.initials: D
authors.lastname: Premprabha
authors.forename: Jitpreedee
authors.initials: J
authors.lastname: Sungsiri
authors.forename: Wittawat
authors.initials: W
authors.lastname: Tantarattanapong
authors.forename: Sorracha
authors.initials: S
authors.lastname: Rookkapan
authors.forename: Pong
authors.initials: P
authors.lastname: Juntarapatin
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000785:Aneurysm, Infected / Q000000981:diagnostic imaging / Q000382:microbiology / Q000401:mortality / Q000601:surgery*; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; 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*; D001027:Aortography / Q000379:methods; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects / Q000401:mortality; D001983:Bronchial Fistula / Q000209:etiology / Q000601:surgery; D057510:Endovascular Procedures / Q000009:adverse effects / Q000401:mortality; D004937:Esophageal Fistula / Q000382:microbiology / Q000601:surgery; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007412:Intestinal Fistula / Q000382:microbiology / Q000601:surgery; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D018570:Risk Assessment; D012307:Risk Factors; D013785:Thailand; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D016157:Vascular Fistula / Q000382:microbiology / Q000601:surgery
chemical_list: D000900:Anti-Bacterial Agents