Skip to main content
SpringerLink
Log in

Arterial Infections in the New Millenium: An Old Problem Revisited

  • Published:
Annals of Vascular Surgery

Abstract

The natural history of infected aneurysms or arterial infections is characterized by rapid expansion leading to rupture, pseudoaneurysm formation, and sepsis. Treatment options include in situ grafting either with prosthetic or autogenous grafts or with cryopreserved allografts (CPAs), resection of the aneurysm with remote bypass grafting, and ligation. The purpose of this study was to review our recent experience with these infections and to present long-term follow-up with in situ CPAs. From January 2000 through June 2005, we treated nine patients with infected aneurysms and one patient with an infection without aneurysm formation. The infection involved the infrarenal abdominal aorta in six patients and the femoral artery in three patients. One patient had an infected splenic artery aneurysm. Aortic rupture occurred in five of the six patients with infected aortas. Two of the three patients with infected femoral aneurysms presented with recurrent hemorrhage. Of the six patients with aortic infections, five were treated with in situ CPAs. One patient was treated with aortic resection and axillofemoral grafting. Two patients with femoral aneurysms were treated with in situ CPAs, and the third patient underwent aneurysm resection and prosthetic grafting through the obturator foramen. The patient with the splenic aneurysm underwent combined valve replacement, aneurysm resection, and splenectomy. Three of the six patients with aortic infections died postoperatively, all of whom were septic at presentation. The cause of death in these three patients was multiple organ failure in two and overwhelming sepsis in one. The three survivors are alive and well with up to 5-year follow-up. The three patients with infected femoral aneurysms are alive and well with follow-up extending to 44 months. The patient with the splenic aneurysm is doing well. No recurrent infections have been noted among the survivors. The CPAs have remained structurally intact in all. The mortality rate among patients with abdominal aortic infections remains high and is likely related to their preoperative septic state. In situ grafting with CPAs appears to be a reasonable treatment option for arterial infections. CPAs appear to maintain their structural integrity and to be resistant to recurrent infection.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1.
Fig. 2.

Similar content being viewed by others

References

  1. Jarrett F, Darling RC, Munduth ED, Austen WG. Experience with infected aneurysms of the abdominal aorta. Arch Surg 1975;110:1281-1286

    PubMed  CAS  Google Scholar 

  2. Oz MC, Brener BJ, Buda JA, et al. A ten-year experience with bacterial aortitis. J Vasc Surg 1989;10:439-449

    Article  PubMed  CAS  Google Scholar 

  3. Oderich GS, Panneton JM, Bower TC, et al. Infected aortic aneurysms: aggressive presentation, complicated early outcome, but durable results. J Vasc Surg 2001;34:900-908

    Article  PubMed  CAS  Google Scholar 

  4. Clagett GP, Valentine RJ, Hagino RT. Autogenous aortoiliac/femoral reconstruction from superficial femoral-popliteal veins: feasibility and durability. J Vasc Surg 1997;25:255-270

    Article  PubMed  CAS  Google Scholar 

  5. Vogt PTL, Brunner-La Rocca HP, Carrel T, et al. Cryopreserved arterial allografts in the treatment of major vascular infection and a comparison with conventional surgical techniques. J Thorac Cardiovasc Surg 1998;116:965-972

    Article  PubMed  CAS  Google Scholar 

  6. Kieffer E, Gomes D, Chiche L, Fléon MH, Kaskas F, Bahini A. Allograft replacement for infrarenal aortic graft infection: early and late results in 179 patients. J Vasc Surg 2004;39:1009-1017

    Article  PubMed  Google Scholar 

  7. Leseche G, Castier Y, Petit MD, et al. Long-term results of cryopreserved arterial allograft reconstruction in infected prosthetic grafts and mycotic aneurysms of the abdominal aorta. J Vasc Surg 2001;34:616-622

    Article  PubMed  CAS  Google Scholar 

  8. Castier Y, Francis F, Cerceau P, et al. Cryopreserved arterial allograft reconstruction for peripheral graft infection. J Vasc Surg 2005;41:30-37

    Article  PubMed  Google Scholar 

  9. Bacourt F, Koskas F. Axillobifemoral artery bypass and aortic exclusion for vascular septic lesions: a multi-centered retrospective study of 98 cases. Ann Vasc Surg 1992;6:119-126

    Article  PubMed  CAS  Google Scholar 

  10. Reddy DJ, Smith RF, Elliott JP, Haddad JK, Wanek EA. Infected femoral artery false aneurysms in drug addicts: evolution of selected vascular reconstruction. J Vasc Surg 1986;3:718-724

    Article  PubMed  CAS  Google Scholar 

  11. Feldman AJ, Berguer R. Management of an infected aneurysm of the groin secondary to drug abuse. Surg Gyencol Obstet 1983;157:519-522

    CAS  Google Scholar 

  12. Brown SL, Busuttil RW, Baker ID, Machleder HI, Moore WS, Barker WF. Bacterial and surgical determinants of survival in patients with mycotic aneurysms. J Vasc Surg 1984;1:541-547

    Article  PubMed  CAS  Google Scholar 

  13. Yasuhara H, Muto T. Infected abdominal aortic aneurysms presenting with sudden appearance: diagnostic importance of serial computed tomography. Ann Vasc Surg 2001;15:582-585

    Article  PubMed  CAS  Google Scholar 

  14. Sessa C, Farah I, Voirin L, Magne JL, Brion JP, Guidicelli H. Infected aneurysms of infrarenal aorta: diagnostic criteria and therapeutic strategy. Ann Vasc Surg 1997;11:453-463

    Article  PubMed  CAS  Google Scholar 

  15. Muckart DJ, Bhagwanjee S. American College of Chest Physicians/Society of Critical Care Medicine Consensus Conference Committee. Definitions of the systemic inflammatory response syndrome and allied disorders in relation to critically injured patients. Crit Care Med 1997;25:1789-1795

    Article  PubMed  CAS  Google Scholar 

  16. Ihaya A, Chiba Y, Kimura T, Morioka K, Uesaka T. Surgical outcome of infectious aneurysm of the abdominal aorta with or without SIRS. Cardiovasc Surg 2001;9:436-440

    Article  PubMed  CAS  Google Scholar 

  17. Fillmore AJ, Valentine RJ. Surgical mortality in patients with infected aneurysms. J Am Coll Surg 2003;196:435-441

    Article  PubMed  Google Scholar 

  18. Moneta GL, Taylor LM, Yeager RA, et al. Surgical treatment of infected aortic aneurysm. Am J Surg 1998;175:396-399

    Article  PubMed  CAS  Google Scholar 

  19. Fichelle JM, Tavet J, Cormier P, et al. Infected infrarenal aortic aneurysms: when is in situ reconstruction safe? J Vasc Surg 1993;17:635-645

    Article  PubMed  CAS  Google Scholar 

  20. Macbeth GA, Rubin JR, McIntyre KE, Goldstone J, Malone JM. The relevance of arterial wall microbiology to the treatment of prosthetic graft infections: graft infection vs. arterial infection. J Vasc Surg 1984;1:750-756

    Article  PubMed  CAS  Google Scholar 

  21. Yeager RA, Taylor LM, Moneta GL, et al. Improved results with conventional management of infrarenal aortic infection. J Vasc Surg 1999;30:76-83

    Article  PubMed  CAS  Google Scholar 

  22. Noel AA, Gloviczki P, Cherry KJ Jr, et al. Abdominal aortic reconstruction in infected fields: early results of the United States Cryopreserved Aortic Allograft Registry. J Vasc Surg 2002;35:847-852

    Article  PubMed  Google Scholar 

  23. Hsu RV, Chen RJ, Wang SS, Chu SH. Infected aortic aneurysms: clinical outcome and risk-factor analysis. J Vasc Surg 2004;40:30-35

    Article  PubMed  Google Scholar 

  24. Sohail MR, Khan AH, Holmes DR, Wilson WR, Steckelberg JM, Baddour LM. Infectious complications of percutaneous vascular closure devices. Mayo Clin Proc 2005;80:1011-1015

    Article  PubMed  Google Scholar 

  25. Bell CL, Ali AT, Brawley JG, et al. Arterial reconstruction of infected femoral artery pseudoaneurysms using superficial femoral-popliteal vein. J Am Coll Surg 2005;200:831-836

    Article  PubMed  Google Scholar 

  26. Treiman GS. Vascular injury secondary to drug abuse. In: Ernest CB, Stanley JC eds. Current Theory in Vascular Surgery, 4th ed. St. Louis: Mosby, 2001:618-624

    Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Vascular Surgery, Methodist Hospital (Clarian Health Partners, Inc.), Indianapolis, IN, USA

    Robert A. McCready MD, M. Ann Bryant MSN, RN, CS, ACNP, Janet L. Divelbiss RN, Bart A. Chess MD, Richard W. Chitwood MD & Douglas S. Paget MD

  2. CorVasc MDs, PC, 1801 N. Senate Boulevard, Suite 755, Indianapolis, IN, 46202, USA

    Robert A. McCready MD

Authors
  1. Robert A. McCready MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. M. Ann Bryant MSN, RN, CS, ACNP
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Janet L. Divelbiss RN
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Bart A. Chess MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Richard W. Chitwood MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Douglas S. Paget MD
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Robert A. McCready MD.

About this article

Cite this article

McCready, R.A., Bryant, M.A., Divelbiss, J.L. et al. Arterial Infections in the New Millenium: An Old Problem Revisited. Ann Vasc Surg 20, 590–595 (2006). https://doi.org/10.1007/s10016-006-9107-y

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10016-006-9107-y

Keywords

Search

Navigation