SURGICAL MANAGEMENT OF MYCOTIC ANEURYSMS AND COMPLICATIONS OF INFECTION IN VASCULAR RECONSTRUCTIVE SURGERY

A series of seventeen mycotic aneurysms treated over the past fifteen years at this institution has been reported. Thirteen of these involved the abdominal aorta and four involved peripheral vessels. Rupture of the aneurysm occurred in ten. There were no survivors in the seven patients with ruptured aneurysms that involved the aorta, four of whom underwent emergency surgery. There were two survivors among the three patients with peripheral ruptured mycotic aneurysms. There were five survivors of the seven with nonruptured aneurysms treated surgically. Four of the six patients with mycotic nonruptured aneurysms of the aorta treated surgically survived and are well at periods of nineteen months to nine years. Three additional successfully managed cases of infection complicating vascular reconstructive procedures have been presented, emphasizing the technics of management. The following factors appear to be of importance to the successful management of mycotic aneurysms or infection complicating vascular reconstructive surgery: (1) early diagnosis and prompt surgery; (2) appropriate pre- and intraoperative antibiotic therapy and postoperative intravenous antibiotic therapy for a period of at least six weeks; (3) resection of infected tissue, foreign material, and adequate drainage; (4) placement of the new graft reconstruction through clean tissue planes; (5) use of wide drainage and local antibiotic irrigation in addition to systemic antibiotics in rare situations in which resection and reconstruction does not seem possible; (6) careful long-term follow-up study. © 1969.