Surgical Outcome for Mycotic Aortic and Iliac Anuerysm

Background The present study was designed to review surgical outcomes for mycotic aneurysm of the aortic or iliac arteries at a single center. Methods The study was based on retrospective chart review of patients undergoing operation for mycotic aneurysm. Results From January 1998 to December 2007, 56 patients received surgical treatment for mycotic aneurysm of the aortic or iliac arteries. Aneurysm sites included the aortic arch ( n = 5), proximal thoracic aorta ( n = 4), distal thoracic aorta ( n = 5), paravisceral aorta ( n = 5), juxtarenal aorta ( n = 4), infrarenal aorta ( n = 30), and iliac arteries ( n = 3). Salmonella was the leading pathogen ( n = 34). Nineteen patients with suprarenal lesions underwent in situ prosthetic graft replacement ( n = 17), extra-anatomic bypass ( n = 1), or endovascular aneurysm repair (EVAR) ( n = 1), and 37 patients with infrarenal lesions underwent the same procedures ( n = 16, 20, and 1, respectively). Overall in-hospital mortality was 23%. After discharge, four patients (7%) developed reinfection that led to fatal sepsis. Graft infection developed after three in situ prosthetic grafts (9%) and one extra-anatomic bypass (5%). Patients with suprarenal aortic lesions had poorer in-hospital (34%) and late (16%) mortality rates than those with infrarenal lesions ( p = 0.025). Those with suprarenal lesions also had a lower cumulative survival rate ( p = 0.016). Conclusions The location of mycotic aneurysm was the determinant of mortality. Mycotic aneurysm of the suprarenal aorta has poor prognosis and requires alternative surgical treatment.