Infected aortic aneurysms: Aggressive presentation, complicated early outcome, but durable results

Gustavo Oderich, Jean M. Panneton, Thomas C. Bower, Kenneth J. Cherry, Charles M. Rowland, Audra A. Noel, John W. Hallett, Peter Gloviczki

Research output: Contribution to journalArticle

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Abstract

Objective: Infected aortic aneurysms are rare, difficult to treat, and associated with significant morbidity. The purpose of this study was to review the management and results of patients with infected aortic aneurysms and identify clinical variables associated with poor outcome. Methods: The clinical data and early and late outcomes of 43 patients treated for infected aortic aneurysms during a 25-year period (1976-2000) were reviewed. Variables were correlated with risk of aneurysm-related death and vascular complications, defined as organ or limb ischemia, graft infection or occlusion, and anastomotic or recurrent aneurysm. Results: Infected aneurysms were infrarenal in only 40% of cases. Seventy percent of patients were immunocompromised hosts. Ninety-three percent had symptoms, and 53% had ruptured aneurysms. Surgical treatment was in situ aortic grafting (35) and extra-anatomic bypass (6). Operative mortality was 21% (9/42). Early vascular complications included ischemic colitis (3), anastomotic disruption (1), peripheral embolism (1), paraplegia (1), and monoparesis (1). Late vascular complications included graft infection (2), recurrent aneurysm (2), limb ischemia (1), and limb occlusion (1). Mean follow-up was 4.3 years. Cumulative survival rates at 1 year and 5 years were 82% and 50%, respectively, significantly lower than survival rates for the general population (96% and 81%) and for the noninfected aortic aneurysm cohort (91% and 69%) at same intervals. Rate of survival free of late graft-related complications was 90% at 1 year and 5 years, similar to that reported for patients who had repair of noninfected abdominal aortic aneurysms (97% and 92%). Variables associated with increased risk of aneurysm-related death included extensive periaortic infection, female sex, Staphylococcus aureus infection, aneurysm rupture, and suprarenal aneurysm location (P < .05). For risk of vascular complications, extensive periaortic infection, female sex, leukocytosis, and hemodynamic instability were positively associated (P < .05). Conclusion: Infected aortic aneurysms have an aggressive presentation and a complicated early outcome. However, late outcome is surprisingly favorable, with no aneurysm-related deaths and a low graft-related complication rate, similar to standard aneurysm repair. In situ aortic grafting is a safe and durable option in most patients.

Original languageEnglish (US)
Pages (from-to)900-908
Number of pages9
JournalJournal of Vascular Surgery
Volume34
Issue number5
DOIs
StatePublished - Jan 1 2001

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Infected Aneurysm
Aortic Aneurysm
Aneurysm
Blood Vessels
Transplants
Infection
Survival Rate
Extremities
Ischemia
Ischemic Colitis
Ruptured Aneurysm
Paraplegia
Leukocytosis
Abdominal Aortic Aneurysm
Immunocompromised Host
Paresis
Embolism
Staphylococcus aureus
Rupture
Hemodynamics

ASJC Scopus subject areas

  • Surgery
  • Cardiology and Cardiovascular Medicine

Cite this

Oderich, G., Panneton, J. M., Bower, T. C., Cherry, K. J., Rowland, C. M., Noel, A. A., ... Gloviczki, P. (2001). Infected aortic aneurysms: Aggressive presentation, complicated early outcome, but durable results. Journal of Vascular Surgery, 34(5), 900-908. https://doi.org/10.1067/mva.2001.118084

Infected aortic aneurysms : Aggressive presentation, complicated early outcome, but durable results. / Oderich, Gustavo; Panneton, Jean M.; Bower, Thomas C.; Cherry, Kenneth J.; Rowland, Charles M.; Noel, Audra A.; Hallett, John W.; Gloviczki, Peter.

In: Journal of Vascular Surgery, Vol. 34, No. 5, 01.01.2001, p. 900-908.

Research output: Contribution to journalArticle

Oderich, G, Panneton, JM, Bower, TC, Cherry, KJ, Rowland, CM, Noel, AA, Hallett, JW & Gloviczki, P 2001, 'Infected aortic aneurysms: Aggressive presentation, complicated early outcome, but durable results', Journal of Vascular Surgery, vol. 34, no. 5, pp. 900-908. https://doi.org/10.1067/mva.2001.118084
Oderich, Gustavo ; Panneton, Jean M. ; Bower, Thomas C. ; Cherry, Kenneth J. ; Rowland, Charles M. ; Noel, Audra A. ; Hallett, John W. ; Gloviczki, Peter. / Infected aortic aneurysms : Aggressive presentation, complicated early outcome, but durable results. In: Journal of Vascular Surgery. 2001 ; Vol. 34, No. 5. pp. 900-908.
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abstract = "Objective: Infected aortic aneurysms are rare, difficult to treat, and associated with significant morbidity. The purpose of this study was to review the management and results of patients with infected aortic aneurysms and identify clinical variables associated with poor outcome. Methods: The clinical data and early and late outcomes of 43 patients treated for infected aortic aneurysms during a 25-year period (1976-2000) were reviewed. Variables were correlated with risk of aneurysm-related death and vascular complications, defined as organ or limb ischemia, graft infection or occlusion, and anastomotic or recurrent aneurysm. Results: Infected aneurysms were infrarenal in only 40{\%} of cases. Seventy percent of patients were immunocompromised hosts. Ninety-three percent had symptoms, and 53{\%} had ruptured aneurysms. Surgical treatment was in situ aortic grafting (35) and extra-anatomic bypass (6). Operative mortality was 21{\%} (9/42). Early vascular complications included ischemic colitis (3), anastomotic disruption (1), peripheral embolism (1), paraplegia (1), and monoparesis (1). Late vascular complications included graft infection (2), recurrent aneurysm (2), limb ischemia (1), and limb occlusion (1). Mean follow-up was 4.3 years. Cumulative survival rates at 1 year and 5 years were 82{\%} and 50{\%}, respectively, significantly lower than survival rates for the general population (96{\%} and 81{\%}) and for the noninfected aortic aneurysm cohort (91{\%} and 69{\%}) at same intervals. Rate of survival free of late graft-related complications was 90{\%} at 1 year and 5 years, similar to that reported for patients who had repair of noninfected abdominal aortic aneurysms (97{\%} and 92{\%}). Variables associated with increased risk of aneurysm-related death included extensive periaortic infection, female sex, Staphylococcus aureus infection, aneurysm rupture, and suprarenal aneurysm location (P < .05). For risk of vascular complications, extensive periaortic infection, female sex, leukocytosis, and hemodynamic instability were positively associated (P < .05). Conclusion: Infected aortic aneurysms have an aggressive presentation and a complicated early outcome. However, late outcome is surprisingly favorable, with no aneurysm-related deaths and a low graft-related complication rate, similar to standard aneurysm repair. In situ aortic grafting is a safe and durable option in most patients.",
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AU - Oderich, Gustavo

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AU - Bower, Thomas C.

AU - Cherry, Kenneth J.

AU - Rowland, Charles M.

AU - Noel, Audra A.

AU - Hallett, John W.

AU - Gloviczki, Peter

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N2 - Objective: Infected aortic aneurysms are rare, difficult to treat, and associated with significant morbidity. The purpose of this study was to review the management and results of patients with infected aortic aneurysms and identify clinical variables associated with poor outcome. Methods: The clinical data and early and late outcomes of 43 patients treated for infected aortic aneurysms during a 25-year period (1976-2000) were reviewed. Variables were correlated with risk of aneurysm-related death and vascular complications, defined as organ or limb ischemia, graft infection or occlusion, and anastomotic or recurrent aneurysm. Results: Infected aneurysms were infrarenal in only 40% of cases. Seventy percent of patients were immunocompromised hosts. Ninety-three percent had symptoms, and 53% had ruptured aneurysms. Surgical treatment was in situ aortic grafting (35) and extra-anatomic bypass (6). Operative mortality was 21% (9/42). Early vascular complications included ischemic colitis (3), anastomotic disruption (1), peripheral embolism (1), paraplegia (1), and monoparesis (1). Late vascular complications included graft infection (2), recurrent aneurysm (2), limb ischemia (1), and limb occlusion (1). Mean follow-up was 4.3 years. Cumulative survival rates at 1 year and 5 years were 82% and 50%, respectively, significantly lower than survival rates for the general population (96% and 81%) and for the noninfected aortic aneurysm cohort (91% and 69%) at same intervals. Rate of survival free of late graft-related complications was 90% at 1 year and 5 years, similar to that reported for patients who had repair of noninfected abdominal aortic aneurysms (97% and 92%). Variables associated with increased risk of aneurysm-related death included extensive periaortic infection, female sex, Staphylococcus aureus infection, aneurysm rupture, and suprarenal aneurysm location (P < .05). For risk of vascular complications, extensive periaortic infection, female sex, leukocytosis, and hemodynamic instability were positively associated (P < .05). Conclusion: Infected aortic aneurysms have an aggressive presentation and a complicated early outcome. However, late outcome is surprisingly favorable, with no aneurysm-related deaths and a low graft-related complication rate, similar to standard aneurysm repair. In situ aortic grafting is a safe and durable option in most patients.

AB - Objective: Infected aortic aneurysms are rare, difficult to treat, and associated with significant morbidity. The purpose of this study was to review the management and results of patients with infected aortic aneurysms and identify clinical variables associated with poor outcome. Methods: The clinical data and early and late outcomes of 43 patients treated for infected aortic aneurysms during a 25-year period (1976-2000) were reviewed. Variables were correlated with risk of aneurysm-related death and vascular complications, defined as organ or limb ischemia, graft infection or occlusion, and anastomotic or recurrent aneurysm. Results: Infected aneurysms were infrarenal in only 40% of cases. Seventy percent of patients were immunocompromised hosts. Ninety-three percent had symptoms, and 53% had ruptured aneurysms. Surgical treatment was in situ aortic grafting (35) and extra-anatomic bypass (6). Operative mortality was 21% (9/42). Early vascular complications included ischemic colitis (3), anastomotic disruption (1), peripheral embolism (1), paraplegia (1), and monoparesis (1). Late vascular complications included graft infection (2), recurrent aneurysm (2), limb ischemia (1), and limb occlusion (1). Mean follow-up was 4.3 years. Cumulative survival rates at 1 year and 5 years were 82% and 50%, respectively, significantly lower than survival rates for the general population (96% and 81%) and for the noninfected aortic aneurysm cohort (91% and 69%) at same intervals. Rate of survival free of late graft-related complications was 90% at 1 year and 5 years, similar to that reported for patients who had repair of noninfected abdominal aortic aneurysms (97% and 92%). Variables associated with increased risk of aneurysm-related death included extensive periaortic infection, female sex, Staphylococcus aureus infection, aneurysm rupture, and suprarenal aneurysm location (P < .05). For risk of vascular complications, extensive periaortic infection, female sex, leukocytosis, and hemodynamic instability were positively associated (P < .05). Conclusion: Infected aortic aneurysms have an aggressive presentation and a complicated early outcome. However, late outcome is surprisingly favorable, with no aneurysm-related deaths and a low graft-related complication rate, similar to standard aneurysm repair. In situ aortic grafting is a safe and durable option in most patients.

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