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.