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The Annals of Thoracic Surgery, Vol 47, 193-203, Copyright © 1989 by The Society of Thoracic Surgeons
FY Chan, ES Crawford, JS Coselli, HJ Safi and TW Williams Jr
Mycotic aneurysms as defined in this study include only those naturally
occurring aortic aneurysms that result from or are secondarily infected by
bacteria arising in a distant site of infection. Of the 2,585 patients
treated for aortic aneurysm during the past 8 1/2 years, 22 patients had
disease conforming to this definition. The aneurysms were located in the
ascending aorta in 2 patients, ascending aorta and arch in 5, arch and
descending aorta in 1, descending thoracic aorta in 1, separate descending
and abdominal aorta in 1, thoracoabdominal aorta in 5, upper abdominal
aorta in 6, and infrarenal abdominal aorta in 1. The primary source of
infection was the urinary tract in 2 patients, salmonellosis in 4,
pneumonia in 3, sub-acute bacterial endocarditis in 2, ear, nose, and
throat in 2, cellulitis of the hand in 1, chronic wounds in 2, dental
extraction in 1, lumbar disc space infection in 1, septic thrombophlebitis
in 1, and generalized febrile illness in 3. The duration of febrile illness
ranged from 2 weeks to 1 year. All patients were treated with antibiotics
and operation was performed within 24 hours after admission in 11 patients
and within one to eight days after admission in 11. Treatment consisted of
in situ graft replacement. Appropriate antibiotics were given intravenously
for 4 to 6 weeks in patients with positive cultures and continued orally
for the rest of the patients' lives. Of the 22 patients, 19 (86%) were
early survivors, and all are still alive 3 months to 8 years
postoperatively. Only 1 had a recurrent infection, which involved the
intervertebral disc space.
ARTICLES
In situ prosthetic graft replacement for mycotic aneurysm of the aorta
Department of Surgery, Baylor College of Medicine, Houston, Texas.
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