Surgery for infected aneurysm of the aortic arch

Objective: Infected aneurysm of the aortic arch is rare and can be fatal without surgery. We report our surgical experience with infected aneurysms of the aortic arch. Method: We conducted a retrospective chart review. Results: Between 1995 and 2006, 10 patients with infected aneurysms of the aortic arch were treated at our hospital. There were 8 men with a median age of 67.5 years (range, 50 - 79 years). The most common pathogen was nontyphoid Salmonella in 5 (50%) patients, followed by Staphylococcus aureus in 2 patients. The site of infection was the aortic arch at the level of the brachiocephalic artery in 1, the left common carotid artery in 4, and the left subclavian artery in 5 patients. All patients underwent in situ graft replacement under deep hypothermic circulatory arrest. There was 1 (10%) hospital death because of persistent infection. Major postoperative complications occurred in 7 (70%) patients, with hypoxic encephalopathy occurring in 4 patients. Late prosthetic graft infection occurred in 1 patient, who died of massive gastrointestinal bleeding 4 months after the operation. Of the 9 patients with distal arch aneurysms, 3 were operated on through a sternotomy with a hospital mortality rate of 33% and an aneurysm-related mortality rate of 67%. The operation was performed through a thoracotomy in 6 patients, with no hospital mortality and an aneurysm- related mortality rate of 17%. Conclusions: Infected aortic arch aneurysm was uncommon and nontyphoid Salmonella was the most common pathogen. Current treatment with in situ graft replacement was associated with high mortality and morbidity. Improvements in cerebral protection and surgical techniques should improve patient outcome.