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

Research output: Contribution to journalArticle

9 Citations (Scopus)

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

Fingerprint

Infected Aneurysm
Aortic Aneurysm
Salmonella
Mortality
Aneurysm
Connective Tissue Diseases
Leukocytosis
Bacteremia
Low Back Pain
Hospital Mortality
Diagnostic Errors
Vascular Diseases
Systemic Lupus Erythematosus
C-Reactive Protein
Population
Stents
Shock
Rheumatoid Arthritis
Cohort Studies
Fever

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

Clinical, microbiologic, and outcome analysis of mycotic aortic aneurysm : The role of endovascular repair. / Huang, Yao Kuang; Chen, Chyi Liang; Lu, Ming Shian; Tsai, Feng Chun; Lin, Pyng Ling; Wu, Chih Hsiung; Chiu, Cheng Hsun.

In: Surgical Infections, Vol. 15, No. 3, 01.06.2014, p. 290-298.

Research output: Contribution to journalArticle

Huang, YK, Chen, CL, Lu, MS, Tsai, FC, Lin, PL, Wu, CH & Chiu, CH 2014, 'Clinical, microbiologic, and outcome analysis of mycotic aortic aneurysm: The role of endovascular repair', Surgical Infections, vol. 15, no. 3, pp. 290-298. https://doi.org/10.1089/sur.2013.011
Huang, Yao Kuang ; Chen, Chyi Liang ; Lu, Ming Shian ; Tsai, Feng Chun ; Lin, Pyng Ling ; Wu, Chih Hsiung ; Chiu, Cheng Hsun. / Clinical, microbiologic, and outcome analysis of mycotic aortic aneurysm : The role of endovascular repair. In: Surgical Infections. 2014 ; Vol. 15, No. 3. pp. 290-298.
@article{91109c5ed7b540d7b4da614f979b32f2,
title = "Clinical, microbiologic, and outcome analysis of mycotic aortic aneurysm: The role of endovascular repair",
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.",
author = "Huang, {Yao Kuang} and Chen, {Chyi Liang} and Lu, {Ming Shian} and Tsai, {Feng Chun} and Lin, {Pyng Ling} and Wu, {Chih Hsiung} and Chiu, {Cheng Hsun}",
year = "2014",
month = "6",
day = "1",
doi = "10.1089/sur.2013.011",
language = "English",
volume = "15",
pages = "290--298",
journal = "Surgical Infections",
issn = "1096-2964",
publisher = "Mary Ann Liebert Inc.",
number = "3",

}

TY - JOUR

T1 - Clinical, microbiologic, and outcome analysis of mycotic aortic aneurysm

T2 - The role of endovascular repair

AU - Huang, Yao Kuang

AU - Chen, Chyi Liang

AU - Lu, Ming Shian

AU - Tsai, Feng Chun

AU - Lin, Pyng Ling

AU - Wu, Chih Hsiung

AU - Chiu, Cheng Hsun

PY - 2014/6/1

Y1 - 2014/6/1

N2 - 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.

AB - 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.

UR - http://www.scopus.com/inward/record.url?scp=84903219677&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84903219677&partnerID=8YFLogxK

U2 - 10.1089/sur.2013.011

DO - 10.1089/sur.2013.011

M3 - Article

VL - 15

SP - 290

EP - 298

JO - Surgical Infections

JF - Surgical Infections

SN - 1096-2964

IS - 3

ER -