Outcomes of Open Repair of Mycotic Descending Thoracic and Thoracoabdominal Aortic Aneurysms

Infected Aortic Aneurysms

“…We also found a favorable outcome in patients with infected aortic aneurysms caused by Salmonella species in our institution. On the other hand, some studies identified a positive culture of non-Salmonella species as a predictor of a poorer outcome after both open surgery and endovascular procedures [17,42,77]. Thus, although still inconclusive, Salmonella infection should at least not be considered as a predictor of a worse outcome for infected aortic aneurysm.…”

“…Patients infected with highly drug-resistant organisms usually require a longer antibiotic therapy duration [76]. Furthermore, since the infected aorta is generally either reconstructed by prosthetic graft implantation or repaired with endovascular prosthesis deployment, suppressive oral antibiotics for a prolonged period following completed parenteral antibiotic therapy is often warranted [18,69,77]. Further details of the antibiotic therapy will be discussed in Sections 7.2 and 7.5.…”

“…Cerebrospinal fluid (CSF) drainage should be routinely performed in all suitable patients, and evoked potential measurement should be considered [83,84]. If the operation is performed with simple aortic clamping, some adjunctive protective measures in addition to CSF drainage could be done, such as hypothermia (cool the patient to 34°C or slightly lower with low operation room temperature or cold intravenous fluid) and cold renal perfusion with crystalloid or blood [77,[83][84][85]. Of note, the adoption of clamp-and-sew technique during an infected thoracic aortic aneurysm repair should be carefully evaluated because excising the infected aorta and performing debridement often takes a considerably more time, which increases the distal ischemic time despite the utilization of various protective strategies.…”

“…Similar to noninfected thoracic and thoracoabdominal aortic aneurysms, an infected thoracic aortic aneurysm is repaired through a left thoracotomy with suitable intercostal spaces or a more extended thoracoabdominal incision [11,77]. A simple clamp-and-sew technique, partial cardiopulmonary bypass, or left heart bypass can be chosen according to the characteristics of the aneurysm and the preference of the surgical team.…”

“…Nevertheless, implanting a vascular prosthesis into a contaminated field in a patient with an active systemic infection might result in a catastrophic graft infection. Thus, the usual practice is to perform the operation after a period of parenteral antibiotic treatment if the patient's condition permits [17,18,77,116].…”