Primary Infected Abdominal Aortic Aneurysm: Surgical Procedures, Early Mortality Rates, and a Survey of the Prevalence of Infectious Organisms over a 30-Year Period

Purpose. The purpose of this study was to analyze the surgical procedures, culture results, and outcomes, and to survey the prevalence of the infectious organisms over a 30-year period in patients with a primary infected abdominal aortic aneurysm (PIAAA). Methods. A total of 11 patients (1.8%) with PIAAA were surgically treated between 1982 and June 2009. All patients had back pain, leukocytosis, and elevated C-reactive protein level. All of the patients underwent either urgent or emergency operations. Results. Cultures of aortic wall specimens and blood were positive in 10 patients and included Salmonella in 2, Streptococcus in 2, Campylobacter fetus in 2, and Listeria, Haemophilus influenzae, Serratia marcescens, Bacteroides thetaiotaomicron, and an unknown organism in 1 patient each. The 10 patients underwent in situ prosthetic grafting with excision of the infected tissue and lavage using 101 saline solution; omentum plasty was required in four patients. An axillofemoral bypass was performed in one patient with pus surrounding the AAA. All 10 patients with in situ replacement survived and were administered intravenous antibiotic therapy for 1 month postoperatively. All of these patients left the hospital without any further complications. However, one patient who underwent an axillofemoral bypass died of overwhelming sepsis. Conclusion. In situ replacement with excision of infected tissue, lavage using 101 saline solution, and omentum plasty for PIAAA successfully resolved the condition. High local concentrations of rifampin-soaked grafts or superficial femoral vein may also be an alternative for an in situ replacement conduit.