Management of infected aortoiliac aneurysms
D. J. Reddy, A. D. Shepard, J. R. Evans, D. J. Wright, R. F. Smith and C. B. Ernst
Department of Surgery, Henry Ford Hospital, Detroit, MI 48202.
A 30-year retrospective review identified 13 patients treated for infected
aneurysms of the abdominal aorta or iliac arteries, for an overall
incidence of 0.65%. A constellation of clinical findings led to the correct
preoperative diagnosis in 11 (85%) of 13 patients. Treatment methods
included resection and in situ replacement grafting in seven patients,
resection and extra-anatomic bypass in five patients, and
resection-ligation in one patient. Four (31%) of 13 patients died within 30
days of operation, three of whom died of rupture. Overall, good results
were achieved in five patients (38%), while poor results were noted in the
remaining eight patients (62%). The determinants of outcome were aneurysm
location or rupture, the presence of established infection, and the
virulence of the infecting organism. In 10 (77%) of the 13 aneurysms,
Salmonella species, Bacteroides fragilis, Staphylococcus aureus, and
Pseudomonas aeruginosa accounted for all deaths, ruptures, and suprarenal
aneurysm infections. These data suggest that patients with primary
infections of the abdominal aorta or iliac arteries continue to present
with advanced infections or aneurysm rupture that result in a high
mortality.
