Faculty Collaboration Database

Surgical management of aortitis with early aneurysmal dilation. Ann Vasc Surg 2014 Apr;28(3):568-74

Date

11/10/2013

Pubmed ID

24200141

DOI

10.1016/j.avsg.2013.06.009

Scopus ID

2-s2.0-84897074706 (requires institutional sign-in at Scopus site)   4 Citations

Abstract

BACKGROUND: Aortitis is a rare and serious condition that requires expedient surgical evaluation. Diagnosis is generally made by computed tomography (CT). Surgery is most often performed when significant aneurysmal changes have already occurred. Outcomes of early surgical management of aortitis with early aneurysmal dilation have not been reported previously.

METHODS: A retrospective review of open abdominal aortic repairs performed from 1999 to 2009 at a single center was done from a prospectively collected database. Patients with a confirmed radiographic appearance of aortitis and treated surgically were selected. Demographic, clinical, and surgical data of patients with aortitis showing early aneurysmal changes (aortic diameter <4 cm) were then analyzed. All aortitis cases with >4-cm aortic diameters and with prosthetic aortic grafts were excluded.

RESULTS: During the observation period, 421 open abdominal aortic repairs were performed. Of these, 10 (2.4%) were identified as having primary aortitis without significant aneurysmal changes. The mean age of the patients was 62 (range 48-77) years. There were 6 (60%) men and 4 (40%) women in the cohort. Four patients (40%) had culture-negative aortitis, whereas 6 (60%) had positive microbial cultures at the time of diagnosis. Paravisceral involvement was seen in 8 (80%) cases. All patients underwent in situ repair with aortic homografts. Mean operative time was 348 minutes and mean estimated blood loss was 2475 mL. Median follow-up time was 23.1 months with a range of 1.7-51.4 months. Operative mortality was 0%, and 1 late death occurred at 23 months postoperatively. There were 9 significant in-hospital (30-day) events occurring in 5 patients, including 3 cardiovascular events, 2 pulmonary events, 3 acute renal failures, and 1 deep surgical site infection.

CONCLUSIONS: Aortitis is an uncommon indication for aortic repair. Infectious aortitis is most commonly confirmed by microbiologic studies, but a significant number of cases have no demonstrable microbial source. Outcomes after early surgical management for aortitis with small aneurysms demonstrated improved mortality when compared with series reviewing outcomes in aortitis patients with large mycotic aneurysms.

Author List

Lee CJ, Kibbe MR, Eskandari MK, Morasch MD, Pearce WH, Rodriguez HE

MESH terms used to index this publication - Major topics in bold

Aged
Aneurysm, Infected
Aorta, Abdominal
Aortic Aneurysm, Abdominal
Aortitis
Aortography
Blood Vessel Prosthesis Implantation
Dilatation, Pathologic
Disease Progression
Early Diagnosis
Female
Hospital Mortality
Humans
Male
Middle Aged
Predictive Value of Tests
Retrospective Studies
Risk Factors
Time Factors
Tomography, X-Ray Computed
Treatment Outcome