Infected abdominal aortic aneurysms. Experience with 14 consecutive cases.

Fourteen patients with infected aortic aneurysms who were admitted to Chulalongkorn Hospital, Bangkok, Thailand from January 1990 to December 1995 were studied. Inclusion criteria were obvious infection found at operations and positive cultures of the aneurysmal sac or contents. Severity of infection found at operations was divided into no, mild, and severe periaortic infection. Eight patients who had no or mild periaortic infection underwent in situ grafting. All of them survived and were discharged home. Four of them are still well at present. None of them developed subsequent graft infection. Of the remaining 6 patients who had severe periaortic infection, one underwent drainage of the retroperitoneal abscess followed by excision of the infected aneurysm and axillobifemoral bypass 2 weeks later. This patient survived and was discharged home but died 4 months later from graft occlusion and sepsis. Of the remaining 5 patients, 3 had in situ grafting and 2 had axillobifemoral bypass. All of them died from sepsis and multiple organ failure in the early postoperative period. Positive culture for gram negative enteric bacteria were obtained in all patients. The study demonstrates that in situ grafting can be safety performed if there is no or only mild periaortic infection and adequate clearance of the infected aorta and periaortic tissue is obtained after an aggressive debridement. A long-term antibiotic administration is recommended.