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Home > Vascular Annual Meeting^® > RR32. Mycotic Supra-renal Aortic Aneurysm...

RR32. Mycotic Supra-renal Aortic Aneurysm: Bacteriology and Surgical Outcome: A Single Center 20-Year Experience

Girma Tefera, John Hoch, Mathew Mell, Charles Acher
University of Wisconsin, School of Medicine and Public Health, Madison, WI

OBJECTIVES: Mycotic supra-renal aneurysm is a rare occurrence however poses unique surgical challenges. The objective of this study was to evaluate outcomes of surgical therapy and associated bacteriology.

METHODS: This is a retrospective study of patients treated at the University of Wisconsin hospital and Clinics over 20-year period from 1988-2008. Patients treated surgically for supra-renal Mycotic Aneurysm were included in this study. Mycotic aneurysm was diagnosed based on imaging, bactriologic finding, clinical and operative findings. Patients demographics, co-morbid condition, symptoms at presentation, location of aneurysm, presence of remote site infection, microbiological findings, surgical approach as well as morbidity and mortality of the procedure were evaluated.

RESULTS: During the study period 700 patients were treated for Thoraco-Abdominal Aortic Aneurysm (TAA), of these 18 patients (2.5%) were diagnosed with mycotic aneurysm. Mean age was 67 years (range 26-80). There were 10 men. Presenting symptoms included pain or fever in 12 and generalized malaise in 8 patients. Fifty percent of the aneurysms (9 patients) were located in the peri-visceral segment of the aorta of these three presented with rupture. Gram stain from aortic wall was positive for bacteria in 14 patients while aortic tissue culture and blood culture were positive for bacteria in only 11 patients respectively. Gram positive organisms were predominant (82%). There was only one case of Salmonella and one Clostridia infection. Remote site of infection was identified in 8 (45%) of the patients. In-situ graft replacement was performed in sixteen (88.9%) patients. Subsequent in-situ graft infection occurred in 1 patient. The in hospital mortality was 16.6% and peri-operative morbidity was as high as 82%. Two of the three patients who died presented with a rupture. There was 1 (5.8%) case of paraplegia and 6 (35%) patients suffered from renal dysfunction.

CONCLUSIONS: In-situ reconstruction for mycotic suprarenal aneurysm resulted in low graft infection rates however peri-operative morbidity and mortality was high. Gram positive micro-organisms are the predominant causative agents.

AUTHOR DISCLOSURES: G. Tefera, None; J. Hoch, None; M. Mell, None; C. Acher, None.