Acute Conditions Caused by Infectious Aortitis

Abstract

Infection of the aorta is rare but potentially very dangerous. Under normal circumstances the aorta is very resistant to infections. Following some afflictions, the infection can pass to the aorta from blood or the surrounding tissues. The authors present their 5-year experience with therapy of various types of infections of the abdominal aorta. Methods: In the 5-year period between January 2008 and December 2012, the Surgical Clinic of the University Hospital in Pilsen treated 17 patients with acute infection of the abdominal aorta. They included 9 males and 8 females. The mean age was 73.05 years (58-90). The most common pathogens were Salmonella (7), Staphylococcus aureus (2), Klebsiella pneumoniae (1), Listeria monocytogenes (1), and Candida albicans (1). Two cases included mixed bacteria and no infectious agent was cultured in three cases. In 14 cases (82.6%) we decided on an open surgical solution, i.e., resection of the affected abdominal aorta, extensive debridement, and vascular reconstruction. In all of these 14 cases we decided on in situ reconstruction. Twelve cases were treated using silver-impregnated prostheses. An antibiotic impregnated graft was used in one case and fresh aortic allograft in one case. In one case (5.9%) we decided on an endovascular solution, i.e., insertion of a bifurcation stent graft and prolonged antibiotic therapy. In two cases (11.8%) we decided on conservative treatment, as both patients refused any surgical therapy. Results: Morbidity was 47.2% (8 patients). In one case we had to perform reoperation of a patient on the 15th postoperative day to evacuate the postoperative hematoma. The 30-day mortality was 5.9% (1 patient). The hospital mortality was 11.8% (2 patients). One patient died on the 42nd postoperative day due to multiorgan failure following resection of perforated aortitis. During follow-up (average 3.5 years), we had no case of infection or thrombosis of the vascular prosthesis. Conclusion: Patients with mycotic aneurysms or acute aortitides face a high risk of death. One can legitimately expect an increase of "aortic infections" to parallel the increase of immunocompromised individuals. Surgical procedures for infectious aortitis are always demanding and require excellent interdisciplinary cooperation, but, as this experience shows, can lead to midterm survival.

Clostridium septicum aortitis: A kiss of the devil

“…Infected aortic aneurysms are rare, accounting for less than 3% of all aneurysms; most commonly caused by Salmonella species or Staphylococcus aureus . Other causes of aortitis include Escherichia coli, Kliebsella pneumoniae, Streptococcus sp., Candida sp., Aspergillus sp., and Listeria monocytogenes . The hallmark of aortitis due to C. septicum is the presence of periaortic gas as reported in 92.6% of cases .…”

Necrotizing Infection of the Aortic Arch: Reconstruction Utilizing Unusual Extra-anatomic Bypass Grafts to Reroute Cerebral Blood Flow

“…Our patient's aortic arch infection was secondary to S. aureus. Although Salmonella aortitis is a well-recognized entity, particularly in the descending and abdominal aorta, 5 infections isolated to the aortic arch tend to have a more varied microbiologic etiology. In a review of nine patients with infected distal arch aneurysms, Okada and associates found S. aureus as the inciting pathogen in two cases, with a myriad of different organisms (all non-Salmonella species) identified in the other cases.…”

A Case of Recurrent Aortic Rupture Associated with Klebsiella pneumoniaePericarditis Treated by Two Separate Aortic Operations

“…In general, the most common bacterial organisms that cause infectious aortic aneurysms are Staphylococcus aureus and Salmonella species. Streptococcus, Pseudomonas, Candida, Cryptococcus, Aspergillus, and Mycobacterium tuberculosis are other sources of infection [ 4 ]. Aortic infections from K. pneumoniae are rare; the few cases of infectious aortic aneurysm caused by K. pneumoniae are mostly reported from eastern Asia, including Japan and Taiwan [ 5 ].…”

“…K. pneumoniae is a gram-negative encapsulated rod. Gram-negative bacteria, including K. pneumoniae , have a higher tendency to expand and rupture the aortic wall than gram-positive bacteria [ 4 ]. K. pneumoniae is generally seen in patients with pneumonia, skin or soft tissue infection, or urinary tract infection.…”