The treatment of infectious aneurysms in the thoracic aorta; our experience in treating five consecutive patients
Masaya Nakashima 1,
Akihiko Usui 1*,
Hideki Oshima 1,
Yuichi Ueda 1
1 Nagoya University Graduate School of Medicine, Japan
* To whom correspondence should be addressed. E-mail: ausui{at}med.nagoya-u.ac.jp.
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Abstract |
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The surgical strategy for infected thoracic aortic aneurysms (ITAA) remains controversial. Effective antibiotic therapy is mandatory and surgical intervention is indicated only to prevent an aneurismal rupture. In-situ reconstruction through an aseptic route is ideal; however, urgent surgery is often required in the uncontrolled infectious phase. Five patients were recently treated surgically for ITAA. They were all males with a mean age of 61.2 (range: 58-66) years. Two patients were operated on urgently in the active infectious phase due to impending aneurysmal rupture. A total arch reconstruction with an extra-anatomical bypass between the ascending aorta and both femoral arteries in one and an extended aortic arch resection with an in-situ graft reconstruction were performed in the other. The other 3 patients underwent in-situ graft reconstructions in the controlled infectious phase. Four patients had multiple aneurysms, including 9 saccular or nodular aneurysms. Short-interval computed tomography (CT) re-examinations revealed a rapid enlargement of the aneurysms and confirmed the diagnosis. All patients successfully survived and are doing well without any evidence of a recurrent aortic infection. The surgical strategy for ITAA should be determined on a case-by-case basis under a careful follow-up with short-interval CT re-examinations. Keywords: Infected aneurysm; Thoracic aneurysm; Surgical reconstruction
