title: Surgical Treatment of Infected Aortoiliac Aneurysm.
abstract: OBJECTIVE
  Infected aneurysms of the abdominal aorta or iliac artery (IAAA) are rare but fatal and difficult to treat. The purpose of this study was to review the clinical presentations and outcomes of IAAA and to establish a treatment strategy for optimal treatment of IAAA.
  
  
  METHODS
  Electronic medical records of 13 patients treated for IAAA at Seoul National University Hospital between March 2004 and December 2012 were retrospectively reviewed.
  
  
  RESULTS
  Mean age was 64.2 (median 70, range 20-79) years. Aneurysms were located in the infrarenal aorta (n=7), iliac arteries (n=5), and suprarenal aorta (n=1). Seven patients underwent excision and in situ interposition graft, 3 underwent extra-anatomical bypass, and 1 underwent endovascular repair. One patient with endovascular repair in an outside hospital refused resection, and only debridement was done, which revealed tuberculosis infection. One staphylococcal infection was caused by iliac stenting. Mycobacterium was the most common pathogen, followed by Klebsiella, Salmonella, and Staphylococcus. There were 3 in-hospital mortalities and the causes were sepsis in 2 and aneurysm rupture in 1. The 3 extra-anatomic bypasses were all patent after 5-year follow-up.
  
  
  CONCLUSIONS
  IAAA develops from various causes and various organisms. IAAA cases with gross pus were treated with extra-anatomic bypass, which was durable. In situ reconstruction is favorable for long term-safety and efficacy, but extensive debridement is essential.
authors.affiliation: Department of Surgery, Seoul National University College of Medicine, Seoul, Korea.
authors.forename: Joong Kee
authors.initials: JK
authors.lastname: Youn
authors.affiliation: Department of Surgery, Hallym University Kangdong Sacred Heart Hospital, Seoul, Korea.
authors.forename: Suh Min
authors.initials: SM
authors.lastname: Kim
authors.affiliation: Department of Surgery, Seoul National University College of Medicine, Seoul, Korea.
authors.forename: Ahram
authors.initials: A
authors.lastname: Han
authors.affiliation: Department of Surgery, Seoul National University College of Medicine, Seoul, Korea.
authors.forename: Chanjoong
authors.initials: C
authors.lastname: Choi
authors.affiliation: Department of Surgery, Seoul National University College of Medicine, Seoul, Korea.
authors.forename: Sang-Il
authors.initials: SI
authors.lastname: Min
authors.affiliation: Department of Surgery, Seoul National University College of Medicine, Seoul, Korea.
authors.forename: Jongwon
authors.initials: J
authors.lastname: Ha
authors.affiliation: Department of Surgery, Myongji Hospital, Goyang, Korea.
authors.forename: Sang Joon
authors.initials: SJ
authors.lastname: Kim
authors.affiliation: Department of Surgery, Seoul National University College of Medicine, Seoul, Korea.
authors.forename: Seung-Kee
authors.initials: SK
authors.lastname: Min
keywords: Bypass; Endovascular procedure; Infected aneurysm; Mycobacterium; Operation