Clinical, microbiologic, and outcome analysis of mycotic aortic aneurysm: The role of endovascular repair

Yao Kuang Huang, Chyi Liang Chen, Ming Shian Lu, Feng Chun Tsai, Pyng Ling Lin, Chih Hsiung Wu, Cheng Hsun Chiu

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Abstract

Background: Mycotic aortic aneurysm (MAA) is an infrequent but devastating form of vascular disease. Methods: We conducted a retrospective cohort study at a major medical center to identify independent risk factors for MAA and to provide opinions about treating it. The study population consisted of 43 patients who had had 44 MAAs over a period of 15 y. Results: All of the patients had positive blood cultures, radiologic findings typical of MAA, and clinical signs of infection (leukocytosis, fever, and elevated C-reactive protein). The mean age of the patients was 63.8±10.6 y and the mean period of their follow up was 35.7±39.3 mo. Twenty-nine patients with MAAs underwent traditional open surgery, 11 others received endovascular stent grafts, and four MAAs were managed conservatively. The most frequent causative pathogens were Salmonella (36/44 patients [81.8%]), in whom organisms of Salmonella serogroup C (consisting mainly of S. choleraesuis) were identified in 14 patients, organisms of Salmonella serogroup D were identified in 13 patients, and species without serogroup information were identified in nine patients. The overall mortality in the study population was 43.2% (with an aneurysm-related mortality of 18.2%, surgically related mortality of 13.6%, and in-hospital mortality of 22.7%). Conclusions: Shock is a risk factor for operative mortality. Misdiagnosis and treatment of MAA as low back pain, co-existing connective-tissue disease such as systemic lupus erythematosus and rheumatoid arthritis, and Salmonella serogroup C-associated bacteremia are risk factors for aneurysm-related death. Endovascular repair should be considered as an alternative option to the open repair of MAA.

Original languageEnglish
Pages (from-to)290-298
Number of pages9
JournalSurgical Infections
Volume15
Issue number3
DOIs
Publication statusPublished - Jun 1 2014

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ASJC Scopus subject areas

  • Surgery
  • Infectious Diseases
  • Microbiology (medical)
  • Medicine(all)

Cite this

Huang, Y. K., Chen, C. L., Lu, M. S., Tsai, F. C., Lin, P. L., Wu, C. H., & Chiu, C. H. (2014). Clinical, microbiologic, and outcome analysis of mycotic aortic aneurysm: The role of endovascular repair. Surgical Infections, 15(3), 290-298. https://doi.org/10.1089/sur.2013.011