Chapter 144 - Infected arterial aneurysms

Question 1

Mycotic aneurysm term origin

Answer 1

Osler 1885 to describe mushroom like eccentric saccular configuration

Question 2

4 classes of infected arterial aneurysms

Answer 2

1) Microbial arteritis witha neurysm formation due to non-cardiac origin bacteremia 2) Post-traumatic infected pseudoaneurysm, illicit drug 3) Infection of pre-existing atherosclerotic aneurysm 4) infected aneurysm from septic emboli

Question 3

Clinical characteristics of infected aneurysms based on 4 classes and common baceriology

Answer 3

TABLE 144.1

Question 4

Microbial arteritis mechanism

Answer 4

1) bacterial seeding in arterial irregularity (atherosclerosis, coarctation, PDA) 2) suppuration and local perf and pseudoaneurysm 3) aorta most common

Question 5

Risk factors of microbial arteritis mechanism

Answer 5

1) DM 2) cirrhosis 3) HD 4) post-transplant immunosuppression 5) HIV 6) alcoholism 7) glucocorticoid therapy 8) chemotherapy 9) malignancy

Question 6

Post-traumatic infected pseudoaneurysm location

Answer 6

1) femoral (access and closure device) 2) carotid 3) brachial 4) external iliac 5) subclavian

Question 7

Percent of infected arterial aneurysm due to emboli

Answer 7

10%

Question 8

Most common organism for infected aneurysm

Answer 8

1) Staphlococcus sp. 28-71% 2) Samonella 15-24% (choleraesuis and enteritidis) 3) Streptococcus < 10%

Question 9

Percentage of blood culture positive in infected aneurysms

Answer 9

50-85% 76% positive aneurysm tissue

Question 10

Organism associated with illicit drug use

Answer 10

MRSA

Question 11

Clostridium septicum aortitis association

Answer 11

1) GI or hematological malignancy 2) rupture and death 64-100%

Question 12

Fungal infection in infected aneurysms - organisms

Answer 12

1) Candida 2) Cryptococcus 3) Aspergillus 4) Pseudallescheria boydii

Question 13

Other rare causes of infected aneurysms

Answer 13

1) Treponema pallidum (Syphilis) 2) mycobacterium 3) Bacillus Calmette-Guerin (bovine TB bacillus) used for intravesical treatment for superficial bladder cancer can cause aneurysm

Question 14

Angiographic findings of infected aneurysm

Answer 14

1) saccular 2) multi-lobulated 3) adjacent soft tissue inflammation and fluid 4) air within aneurysm 5) air in aneurysm wall 6) signs of rupture 7) rapid enlargement

Question 15

Antibiotic regimen in infected aneurysm therapy

Answer 15

1) Broad spectrum 2) 6 weeks post-surgery

Question 16

Aortic portions to be infected - percentage

Answer 16

Infrarenal 40% distal thoracic 16% thoracoabdominal 16% paravisceral 13% juxtarenal 4%

Question 17

Exclusion bypass by Kiefer - describe

Answer 17

Ascending aorta to infrarenal aorta bypass with prosthetic graft Staple close distal aortic arch and supraceliar aorta

Question 18

Mortality in med-managed thoracoabdominal infected aneurysm

Answer 18

85%

Question 19

Surgical mortality of infected AAA

Answer 19

15-38%

Question 20

Cryograft for infected aorta survival at 1 year and 5 year along

Answer 20

1 year 75% 5 year 51%

Question 21

Allograft reconstruction complications in infected aortic aneurysms

Answer 21

1) peri-anastomotic hemorrhage 2) graft limb occlusion 3) pseudoaneurysm

Question 22

Re infection rates in antibiotic soaked Dacron grafts

Answer 22

4-22%

Question 23

1, 5 and 10 year mortality after rifampin soaked graft in infected aneurysms

Answer 23

1 year 85% 5 year 59% 10 year 40%

Question 24

NAIS described first by

Answer 24

Clagett

Question 25

Reinfection after NAIS for infected aorta

Answer 25

2%

Question 26

Primary patency of NAIS

Answer 26

2 year 87% 5 year 82% Primary assisted 94-96%

Question 27

Mortality of NAIS in hospital and 5 year

Answer 27

10% 30 day 60% 5 year

Question 28

Rate of fasciotomy after NAIS

Answer 28

12% higher in previous GSV harvest

Question 29

Chronic venous insufficiency after NAIS

Answer 29

15%

Question 30

Rate of aortic stump blow out after infection repair

Answer 30

12%

Question 31

5 year patency of Ax-fem graft

Answer 31

70%

Question 32

Rate of infection in ax-fem

Answer 32

6-20%

Question 33

Mortality of aortic-aero-digestive fistula

Answer 33

67%

Question 34

Rate of infection after femoral perc procedure

Answer 34

1%

Question 35

Rate of amputation if CFA, PFA, SFA ligated in infection

Answer 35

33% Single artery ligation does not result in amputation

Question 36

Rate of neurologic events after ligating ICA

Answer 36

20-60%

Question 37

Stump pressure suggesting safe ICA ligation

Answer 37

> 70 mmHg

Question 38

Rate of synchronous infected aneurysm in the presence of an SMA aneurysm

Answer 38

19%

Question 39

Rupture rate in SMA aneurysms

Answer 39

38-50%

Question 40

Mortality after SMA aneurysm rupture

Answer 40

30%