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Mycotic Aneurysms in the Abdominal Aorta and Iliac Arteries: CT-based Grading and Correlation with Surgical Outcomes

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Abstract

Background

Computed tomography (CT) is the modality of choice in the diagnosis of mycotic aneurysms. The present study aimed to classify the CT findings of mycotic aneurysms, and to assess their predictive value based on the correlation of a CT-based grading system with prognostic factors and outcomes.

Methods

Over the past 21 years, 40 consecutive patients underwent open surgery for mycotic aneurysms of the abdominal aorta and iliac arteries in our hospital. The CT appearances of mycotic aneurysms were categorized into four grades: grade 1, periarterial changes without destruction of the arterial wall; grade 2, presence of saccular outpouching; grade 3, extensive retroperitoneal infection; and grade 4, massive perianeurysmal hemorrhage. Clinical data were recorded for analysis.

Results

The surgical mortality and overall aneurysm-related mortality rates were 17.5 and 25 %, respectively. The poor prognostic predictors were shock, rupture, and concomitant gastrointestinal procedures. The increasing proportions of shock and rupture status corresponded to mycotic aneurysms of higher grades in the CT-based grading. In addition, one patient in grades 1 and 2, versus five in grades 3 and 4 (P = 0.02), required concomitant gastrointestinal procedures. The CT-based grading exhibited a strong association with surgical mortality (Cramer’s V coefficient = 0.65; P = 0.002) and a relatively strong association with overall aneurysm-related mortality (Cramer’s V coefficient = 0.53; P = 0.01).

Conclusions

For patients surgically treated for abdominal mycotic aneurysms, the CT-based grading is correlated with clinical severity, surgical complexity, and outcomes, and thus it may serve as a simple scale for risk classification.

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Acknowledgments

The authors are grateful to Shan-Tair Wang and Yu-Yi Chen for valuable assistance in statistical analysis and manuscript preparation.

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Authors and Affiliations

  1. Institute of Clinical Medicine, College of Medicine, National Cheng Kung University Hospital, National Cheng Kung University, Tainan, Taiwan

    Chao-Han Lai & Pao-Yen Lin

  2. Department of Surgery, College of Medicine, National Cheng Kung University Hospital, National Cheng Kung University, No. 138, Sheng-Li Road, Tainan, 704, Taiwan

    Chao-Han Lai, Chwan-Yau Luo, Chung-Dann Kan, Pao-Yen Lin & Yu-Jen Yang

  3. Department of Surgery, National Cheng Kung University Hospital Dou-liou Branch, Yunlin, Taiwan

    Chao-Han Lai

  4. Department of Radiology, National Cheng Kung University Hospital Dou-liou Branch, Yunlin, Taiwan

    Ruey-Sheng Chang

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  1. Chao-Han Lai
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Correspondence to Yu-Jen Yang.

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Lai, CH., Chang, RS., Luo, CY. et al. Mycotic Aneurysms in the Abdominal Aorta and Iliac Arteries: CT-based Grading and Correlation with Surgical Outcomes. World J Surg 37, 671–679 (2013). https://doi.org/10.1007/s00268-012-1850-3

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