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Experience With Infected Aneurysms of the Abdominal Aorta

Experience With Infected Aneurysms of the Abdominal Aorta Abstract • Seventeen consecutive patients with abdominal aortic aneurysms were treated during a 14-year period. Fever was the most common symptom first to appear (12 patients), either as fever of unknown origin or in association with other symptoms. Several factors raise the suspicion of an infected aneurysm: positive blood cultures, erosion of lumbar vertebrae, lack of aortic calcification, aneurysms found in female patients or after a prolonged illness of bacteremia. Staphylococci (41%) and Salmonella (18%) were the most common organisms. Aneurysms with Gramnegative organisms exhibited a greater tendency toward early rupture than those with Gram-positive organisms (84% vs 10%), and were associated with a higher mortality. Delay in making the diagnosis adversely affected the death rate. "Infected aneurysm" is suggested as a better term than "mycotic aneurysm," since fungi are rarely involved. (Arch Surg 110:1281-1286, 1975) References 1. Thompson JE, Hollier LH, Patman RD, et al: Surgical management of abdominal aortic aneurysms: Factors influencing mortality and morbidity—A 20 year experience . Ann Surg 181:654-661, 1975.Crossref 2. Koch L: Ueber das Aneurysma der Anteria meseraica, dissertation. Erlangen, JJ Barfies, 1851. 3. Osler W: Gulstonian lectures on malignant endocarditis . Br Med J 1:467-470, 1885.Crossref 4. Anderson CB, Butcher HR, Ballinger WF: Mycotic aneurysms . Arch Surg 109:712-717, 1974.Crossref 5. Stengel A, Wolferth CC: Mycotic (bacterial) aneurysms of intravascular origin . Arch Intern Med 31:527-554, 1923.Crossref 6. Parkhurst GF, Decker JP: Bacterial aortitis of mycotic aneurysm of the aorta: A report of 12 cases . Am J Pathol 31:821-835, 1955. 7. Bennett DE, Cherry JK: Bacterial infection of aortic aneurysms . Am J Surg 113:321-326, 1967.Crossref 8. Sommerville RL, Allen EV, Edwards JE: Bland and infected arteriosclerotic abdominal aortic aneurysms: A clinicopathologic study . Medicine 38:207-221, 1959.Crossref 9. Bennett DE: Primary mycotic aneurysms of the aorta . Arch Surg 94:758-765, 1967.Crossref 10. Finseth F, Abbott WM: One stage operative therapy for Salmonella mycotic abdominal aortic aneurysm . Ann Surg 179:8-11, 1974.Crossref 11. Smith RF, Szilagyi DE, Colville JM: Surgical treatment of mycotic aneurysms . Arch Surg 85:663-674, 1962.Crossref 12. Ten Eyck FW, Osmunson PJ, Brandenburg RO, et al: Aneurysms of the abdominal aorta and fever . Mayo Clin Proc 35:1-7, 1960. 13. Lange K: Osteomyelitis der Wirbelsaule und Aneurysma der Aorta abdominalis . Chirug 19:180-184, 1948. 14. Mundth ED, Darling RC, Alvarado RH, et al: Surgical management of mycotic aneurysms and the complications of infection in vascular reconstructive surgery . Am J Surg 117:460-470, 1969.Crossref 15. Barker WF: Mycotic aneurysms . Ann Surg 139:84-89, 1954.Crossref 16. Nabseth DC, Deterling RA: Surgical management of mycotic aneurysms . Surgery 50:347-353, 1961. 17. Fromm SH, Lucas CE: Obturator bypass for mycotic aneurysm in the drug addict . Arch Surg 100:82-83, 1970.Crossref 18. Brewster DC, Retona A, Waltman AC, et al: Angiography in the management of aneurysms of the abdominal aorta: Its value and safety . N Engl J Med 292:822-825, 1975.Crossref 19. Weintraub RA, Abrams HL: Mycotic aneurysms . Am J Radiol 102:354-362, 1968. 20. Sower ND, Whelan TJ: Suppurative ateritis due to Salmonella . Surgery 52:851-859, 1962. 21. Zak FG, Strauss L, Saphra I: Rupture of diseased large arteries in the course of enterobacterial (Salmonella) infections . N Engl J Med 258:824-828, 1958.Crossref 22. Carter SC, Cohen A, Whelan TJ: Clinical experience with management of the infected Dacron graft . Ann Surg 158:249-255, 1963.Crossref 23. Meade RH, Moran JM: Salmonella arteritis-preoperative diagnosis and cure of Salmonella typhimurium aortic aneurysm . N Engl J Med 281:310-312, 1969.Crossref 24. Cliff MM, Soulen RL, Finestone AJ: Mycotic aneurysms-a challenge and a clue . Arch Intern Med 126:977-982, 1970.Crossref 25. Reichle FA, Tyson RR, Soloff LA, et al: Salmonellosis and aneurysm of the distal abdominal aorta . Ann Surg 171:219-228, 1970.Crossref 26. Linton RR: The prophylactic use of antibiotics in clean surgery . Surg Gynecol Obstet 112:218-220, 1961. 27. Blaisdell FW, DeMattei GA, Gander PJ: Extraperitoneal thoracic aorta to femoral bypass graft or replacement for an infected aortic bifurcation prosthesis . Am J Surg 102:583-585, 1961.Crossref 28. Mannick JA: Complications of peripheral arterial surgery and their management . Am J Surg 116:387-395, 1968.Crossref http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Surgery American Medical Association

Experience With Infected Aneurysms of the Abdominal Aorta

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Publisher
American Medical Association
Copyright
Copyright © 1975 American Medical Association. All Rights Reserved.
ISSN
0004-0010
eISSN
1538-3644
DOI
10.1001/archsurg.1975.01360170021002
Publisher site
See Article on Publisher Site

Abstract

Abstract • Seventeen consecutive patients with abdominal aortic aneurysms were treated during a 14-year period. Fever was the most common symptom first to appear (12 patients), either as fever of unknown origin or in association with other symptoms. Several factors raise the suspicion of an infected aneurysm: positive blood cultures, erosion of lumbar vertebrae, lack of aortic calcification, aneurysms found in female patients or after a prolonged illness of bacteremia. Staphylococci (41%) and Salmonella (18%) were the most common organisms. Aneurysms with Gramnegative organisms exhibited a greater tendency toward early rupture than those with Gram-positive organisms (84% vs 10%), and were associated with a higher mortality. Delay in making the diagnosis adversely affected the death rate. "Infected aneurysm" is suggested as a better term than "mycotic aneurysm," since fungi are rarely involved. (Arch Surg 110:1281-1286, 1975) References 1. Thompson JE, Hollier LH, Patman RD, et al: Surgical management of abdominal aortic aneurysms: Factors influencing mortality and morbidity—A 20 year experience . Ann Surg 181:654-661, 1975.Crossref 2. Koch L: Ueber das Aneurysma der Anteria meseraica, dissertation. Erlangen, JJ Barfies, 1851. 3. Osler W: Gulstonian lectures on malignant endocarditis . Br Med J 1:467-470, 1885.Crossref 4. Anderson CB, Butcher HR, Ballinger WF: Mycotic aneurysms . Arch Surg 109:712-717, 1974.Crossref 5. Stengel A, Wolferth CC: Mycotic (bacterial) aneurysms of intravascular origin . Arch Intern Med 31:527-554, 1923.Crossref 6. Parkhurst GF, Decker JP: Bacterial aortitis of mycotic aneurysm of the aorta: A report of 12 cases . Am J Pathol 31:821-835, 1955. 7. Bennett DE, Cherry JK: Bacterial infection of aortic aneurysms . Am J Surg 113:321-326, 1967.Crossref 8. Sommerville RL, Allen EV, Edwards JE: Bland and infected arteriosclerotic abdominal aortic aneurysms: A clinicopathologic study . Medicine 38:207-221, 1959.Crossref 9. Bennett DE: Primary mycotic aneurysms of the aorta . Arch Surg 94:758-765, 1967.Crossref 10. Finseth F, Abbott WM: One stage operative therapy for Salmonella mycotic abdominal aortic aneurysm . Ann Surg 179:8-11, 1974.Crossref 11. Smith RF, Szilagyi DE, Colville JM: Surgical treatment of mycotic aneurysms . Arch Surg 85:663-674, 1962.Crossref 12. Ten Eyck FW, Osmunson PJ, Brandenburg RO, et al: Aneurysms of the abdominal aorta and fever . Mayo Clin Proc 35:1-7, 1960. 13. Lange K: Osteomyelitis der Wirbelsaule und Aneurysma der Aorta abdominalis . Chirug 19:180-184, 1948. 14. Mundth ED, Darling RC, Alvarado RH, et al: Surgical management of mycotic aneurysms and the complications of infection in vascular reconstructive surgery . Am J Surg 117:460-470, 1969.Crossref 15. Barker WF: Mycotic aneurysms . Ann Surg 139:84-89, 1954.Crossref 16. Nabseth DC, Deterling RA: Surgical management of mycotic aneurysms . Surgery 50:347-353, 1961. 17. Fromm SH, Lucas CE: Obturator bypass for mycotic aneurysm in the drug addict . Arch Surg 100:82-83, 1970.Crossref 18. Brewster DC, Retona A, Waltman AC, et al: Angiography in the management of aneurysms of the abdominal aorta: Its value and safety . N Engl J Med 292:822-825, 1975.Crossref 19. Weintraub RA, Abrams HL: Mycotic aneurysms . Am J Radiol 102:354-362, 1968. 20. Sower ND, Whelan TJ: Suppurative ateritis due to Salmonella . Surgery 52:851-859, 1962. 21. Zak FG, Strauss L, Saphra I: Rupture of diseased large arteries in the course of enterobacterial (Salmonella) infections . N Engl J Med 258:824-828, 1958.Crossref 22. Carter SC, Cohen A, Whelan TJ: Clinical experience with management of the infected Dacron graft . Ann Surg 158:249-255, 1963.Crossref 23. Meade RH, Moran JM: Salmonella arteritis-preoperative diagnosis and cure of Salmonella typhimurium aortic aneurysm . N Engl J Med 281:310-312, 1969.Crossref 24. Cliff MM, Soulen RL, Finestone AJ: Mycotic aneurysms-a challenge and a clue . Arch Intern Med 126:977-982, 1970.Crossref 25. Reichle FA, Tyson RR, Soloff LA, et al: Salmonellosis and aneurysm of the distal abdominal aorta . Ann Surg 171:219-228, 1970.Crossref 26. Linton RR: The prophylactic use of antibiotics in clean surgery . Surg Gynecol Obstet 112:218-220, 1961. 27. Blaisdell FW, DeMattei GA, Gander PJ: Extraperitoneal thoracic aorta to femoral bypass graft or replacement for an infected aortic bifurcation prosthesis . Am J Surg 102:583-585, 1961.Crossref 28. Mannick JA: Complications of peripheral arterial surgery and their management . Am J Surg 116:387-395, 1968.Crossref

Journal

Archives of SurgeryAmerican Medical Association

Published: Nov 1, 1975

References