Nawaphan Taengsakul* and Pisake Boontham
Department of Surgery, Phramongkutklao Hospital, ThailandFulltext PDF
Introduction: Infected Aortic Aneurysm (IAA) is rare condition but has high mortality rate. Open surgical repair is goal standard treatment of IAA, however, in the last decades; endovascular treatment became the alternative treatment for high risk patients and preferred treatment in many centers. The aim of this study was to evaluate the predictive factors of persistent infection and mortality rate, and to report outcome of endovascular treatment.
Method: This study was retrospective analysis of 40 consecutive IAA patients undergoing treatment in single center from 2008 to 2017. Demographic data, clinical presentation, imaging characteristic and treatment were analyzed by univariate and multivariate logistic regression to assess risk factors of poor treatment outcome. Cumulative survival rate was calculated by Kaplan Meier method.
Result: We identified 31 patients with the average age of 66 years (40 years to 89 years), 26 out of 31 (83.9%) patients were male. The most common presentations were abdominal or back pain, fever and shock (90.3%, 41.9% and 38.7% respectively). Bacterial hemoculture was positive in only 41.3% of patients and the two most common pathogens identified were Staphylococcus aureus (19.4%) and Salmonella group D species (16.1%). Most common location of aneurysm was infrarenal type (87.1%). Persistent infection was only one third of cases. The presences of shock and aortoenteric fistula were the predictive factors of persistent infection. There were increasing mortality rate in patients with COPD, leukocytosis (WBC >10,000 cell/cm3), positive bacterial hemoculture especially Staphylococcus aureus and Salmonella group D species, and imaging characteristic of periaortic gas. Endovascular treatment improved survival rate significantly.
Conclusion: IAA has high mortality and was highly concerned for persistent infection. Presentation of shock was the predictive factors of persistent infection and higher mortality rate. Endovascular treatment was the appropriate alternative treatment for IAA and improved survival rate compared with conventional open treatment.
Taengsakul N, Boontham P. Infected Aortic Aneurysm: Experience of Phramongkutklao Army Hospital. World J Vasc Surg. 2018; 1(2): 1011.