title: Treatment of primary infected aortic aneurysm without aortic resection.
abstract: BACKGROUND
  We sought to determine the safety and efficacy of two different treatment strategies for patients with primary infected aortic aneurysms, including antibiotic treatment alone and endovascular aneurysm repair (EVAR) with aggressive antibiotic treatment, as alternatives to the established treatment of open surgical repair.
  
  
  METHODS
  We conducted a retrospective chart review of patients who were treated for infected aortic aneurysm without undergoing aortic resection from January 2000 to December 2010 at a single institution.
  
  
  RESULTS
  A total of 40 patients underwent traditional open repair during the study period. Sixteen patients with infected aortic aneurysm (11 men; median age, 70; range, 44-80 years) were identified as not having undergone aortic resection during the 11 years reviewed in the study. Nine patients received antibiotic treatment only (group I) and seven patients underwent EVAR with aggressive antibiotic treatment (group II). Salmonella species were isolated from seven patients in group I, and oxacillin-resistant Staphylococcus aureus was isolated from the remaining two patients. In group II, six patients had blood culture results showing Salmonella species and one patient had a blood culture result showing Escherichia coli. Group I (7 of 9 patients; 78%) had a higher hospital mortality rate than group II (0%; P = .003). Mean follow-up among survivors was 10 ± 15 months (range, 1-37 months). One patient in group II developed a reinfection episode (14%). There was no significant difference between group I (67%; SE, 27.2%) and group II (86%; SE, 13.2%) in the 3-month survival rates (log-rank, P = .39).
  
  
  CONCLUSIONS
  Our results support the premise that EVAR is beneficial for the patients with infected aortic aneurysm. Treating an infected aortic aneurysm with antibiotics alone could not stop aneurysm expansion and eradicate the aortic infection before the aneurysm ruptures. For the patients with infected aortic aneurysms who have limited life expectancy and multiple comorbidities, EVAR with aggressive antibiotic treatment should be considered preferentially over antibiotic treatment alone.
authors.affiliation: Division of Thoracic and Cardiovascular Surgery, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan, Province of China.
authors.forename: Sheng-Yueh
authors.initials: SY
authors.lastname: Yu
authors.forename: Chun-Hui
authors.initials: CH
authors.lastname: Lee
authors.forename: Hung-Chang
authors.initials: HC
authors.lastname: Hsieh
authors.forename: An-Hsun
authors.initials: AH
authors.lastname: Chou
authors.forename: Po-Jen
authors.initials: PJ
authors.lastname: Ko
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000785:Aneurysm, Infected / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D001014:Aortic Aneurysm / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D001807:Blood Vessel Prosthesis; D019917:Blood Vessel Prosthesis Implantation; D003131:Combined Modality Therapy; D057510:Endovascular Procedures; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012480:Salmonella Infections / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D013203:Staphylococcal Infections / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*
chemical_list: D000900:Anti-Bacterial Agents