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OBJECTIVES: Para-visceral involvement in mycotic aortic aneurysms makes repair challenging given that standard extra-anatomical axillo-bifemoral bypass precludes visceral perfusion. The aim of this study was to evaluate our experience in the management of mycotic para-visceral aneurysms.
METHODS: Data from six patients with infected para-visceral aneurysms from January 1994 to August 2013 were retrospectively reviewed.
RESULTS: There were five males and one female. Median age was 64 years (4 months-80 years). Primary sources of infection included: vertebral osteomyelitis in two, endocarditis, lymphangitis, previous Mycobacterial infection and severe caries in one each. Five of the repairs were performed through a midline, trans-peritoneal approach and one through a thoraco-abdominal approach. Four synthetic grafts previously soaked in Rifampin and two cryopreserved homografts were used to replace the excised infected aorta. Four grafts were placed in-situ and two were routed extra-anatomically within the abdomen. Renal/visceral reconstruction was performed with synthetic bypasses in two, with saphenous vein in one and with homograft in one. Omentoplasty was performed in all. Temporary axillo-femoral bypass was utilized in one patient. Microorganisms isolated include: coagulase negative Staphylococcus and Proprionebacterium agnes in two; Streptococcus, Coxiella burnetti and Staphylococcus aureus in one each. All patients survived the initial post-operative period without requiring dialysis. Three patients died at post-operative days 23, 37 and 56 due to aspiration, multisystem organ failure and ruptured diverticulitis respectively. Mean follow-up was 24 months (1 month-70 months). All survivors are currently receiving indefinite suppressive antibiotic therapy. There are no recurrences
CONCLUSIONS: Trans-abdominal repair of mycotic para-visceral aneurysms are challenging, however, they can be performed with low immediate mortality and satisfactory mid-term results.