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Therapeutic Implications

Marc M. Sedwitz, MD; Robert J. Hye, MD; Bruce E. Stabile, MD

Arch Surg. 1988;123(4):473-476.

Abstract
• To elucidate newly emerging trends in pseudoaneurysm causation, 57 patients with 81 pseudoaneurysms were reviewed. Only two (8%) of 24 pseudoaneurysms treated surgically before 1977 were infected, whereas 17 (30%) of 57 treated during the past decade were infected. There were four deaths among 12 patients (33%) with infected pseudoaneurysms compared with only one death among 45 patients (2%) with noninfected pseudoaneurysms. All five amputations were consequences of infected pseudoaneurysms. We conclude that (1) infection as a cause of pseudoaneurysm is increasing, (2) mortality and limb loss are now confined almost exclusively to cases involving infection, and (3) the current approach to pseudoaneurysm should include a high index of suspicion in patients at risk for infection, increased use of newer diagnostic scans, and an aggressive surgical attack on infected pseudoaneurysms that may require complete graft excision and extraanatomic bypass.

(Arch Surg 1988;123:473-476)

Author Affiliations
From the Vascular Surgery Section (Drs Sedwitz and Hye) and the Surgical Service (Dr Stabile), Veterans Administration Medical Center; and the Department of Surgery, School of Medicine, University of California (Drs Sedwitz, Hye, and Stabile), San Diego.

Footnotes
Accepted for publication Sept 25, 1987.

Read before the Association of Veterans Administration Surgeons, Portland, Ore, May 9, 1987.

Reprint requests to Surgical Service (112), Veterans Administration Medical Center, 3350 La Jolla Village Dr, San Diego, CA 92161 (Dr Sedwitz).

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