Abstract
We examined the surgical results and late outcome of the extra-anatomic bypass for infected abdominal aortic aneurysm. Seven patients, all male, underwent operations in our institution and had a mean age of 68.4 years (ranging from 56 to 87 years). Our surgical procedure was an extra-anatomic bypass grafting (6 axillo-bilateral femoral bypasses and 1 bilateral axillo-femoral bypass). At the first phase of the operation, we resected the aneurismal wall and debrided all infected tissue. Aortic and iliac arterial stumps were closed by direct sutures and covered by the greater ometum. All patients had fever, 5 had leukocytosis and positive blood culture was revealed only in 4 cases. The CT (computed tomography) findings revealed saccular or pseudoanurysm in all patients. The CT examination was the most useful method in diagnosing infected abdominal aortic aneurysm. Infected abdominal aortic aneurysms were caused by Salmonella in 4 patients, Bacteroides in 1 patient, Klebsiella in another and unknown the cause was in another. The post-operative early complications consisted of an aortic stump disruption due to retroperitoneal abscess in 1 patient, infected thoracic aortic aneurysm, ureteral injury and liver damage in the others. There were no hospital deaths and all patients went home. A late event was a left renal abscess in 1 patient who underwent left nephrectomy and drainage 14 months after his aneurysm operation. Unilateral bypass graft occlusion occurred in the bilateral axillo-femoral bypass graft, and he underwent femoro-femoral crossover bypass grafting 12 months after his operation. Late death occurred with 1 patient due to cerebral vascular disease, but the other patients have been followed-up for 15 to 132 months after their operations. No one had aortic stump disruption, recurrence of infected aneurysm or limb ischemia. We concluded that the extra-anatomic bypass for infected abdominal aortic aneurysm is a safe and reliable method.
