Single-center experience with open surgical treatment of 36 infected aneurysms of the thoracic, thoracoabdominal, and abdominal aorta.

Background To describe a single-center experience with open surgical treatment of infected aortic aneurysms. We analyzed risk factors for 90-day mortality. Methods Between 1983 and 2008, 4,410 patients underwent open surgery for thoracic, thoracoabdominal, or abdominal aneurysm at our institution. Primary infection of the aneurysm was suspected because of clinical signs of infection in combination with typical radiological and morphological aspects in 66 patients (1.5%). In all, 36 patients displayed 10 different kinds of organisms in cultures of blood and/or intraoperative specimens and were further analyzed. Results The group consisted of 23 men and 13 women, with a mean age of 66.8 ± 8 (50-84) years. Location of the aneurysm was thoracic in five patients (14%), thoracoabdominal in 13 patients (36%), and abdominal in 18 patients (50%). Eleven patients (28%) were treated before and 25 (72%) after 1995. We found free rupture in three cases; contained rupture into surrounding tissue in 23 cases (64%); penetration into lung, bronchus, esophagus, or inferior vena cava in five cases; and an intact aneurysm in another five cases. Kinds of surgery were as follows: extra-anatomic revascularization in four patients (11%), Dacron patch plasty in four patients (11%), in situ revascularization in 24 patients (66%), and four patients died during surgery before reconstruction (11%). In all, 13 patients died during hospital stay (36%). In 25 patients treated after 1995, 90-day mortality was 24% and was significantly better ( p Conclusions Outcome of patients with infected aortic aneurysms has improved during the last 15 years and depends on the status of rupture at time of surgery. Therefore, only early diagnosis and early treatment can further improve the prognosis.