Surgical pathology of infected aneurysms of the descending thoracic and abdominal aorta: Clinicopathologic correlations in 29 cases (1976 to 1999)

doi:10.1016/j.humpath.2004.05.013

Human Pathology

Volume 35, Issue 9, September 2004, Pages 1112-1120

https://doi.org/10.1016/j.humpath.2004.05.013 Get rights and content

Abstract

Infected aortic aneurysms are uncommon, and only rarely have their surgical pathological features been described. Clinical and histopathologic features were evaluated in patients undergoing surgical repair of infected aneurysms of the descending thoracic or abdominal aorta over a 24-year period. Findings were compared with observations (primarily from autopsy studies) from the previous 25-year period (1950 to 1975) and other more recent reports. Of the 29 patients in our study, 79% were men, 90% had risk factors for atherosclerosis, and 72% had an identifiable risk or source of infection. Fever was present in 76%, and abdominal or back pain was seen in 66%. Among the 20 cases with an identifiable causative organism, staphylococcus accounted for 30%, streptococcus for 20%, salmonella for 20%, Escherichia coli for 15%, and other organisms for 15%. Aneurysms were saccular in 59% and infrarenal in 42%, and had a mean diameter of 5.6 cm. Microscopically, 6 patterns were recognized: acute inflammation superimposed on severe chronic atherosclerosis (55%), atherosclerosis with chronic inflammation (20%), acute inflammation without atherosclerosis (7%), chronic adventitial inflammation (7%), pseudoaneurysm formation (7%), and necrotizing granulomatous inflammation (4%). Special stains for organisms were positive in only 38% of the cases. Pathological findings of this series of surgical specimens spanning the fourth quarter of the twentieth century were not appreciably different from those described in autopsy series from the preceding years, although the causative microorganisms and agents used to treat them, preoperative diagnostic modalities, and surgical approaches have evolved.

Section snippets

Patient selection

The study design was approved by the Mayo Foundation Institutional Review Board. All patients who had undergone aortic reconstruction for aneurysms distal to the left subclavian artery between January 1, 1976 and December 31, 1999 were identified retrospectively in the surgical database of Mayo Clinic Rochester. Patients were defined as having infective aortitis based on clinical evidence of infection, such as fever, pain, and leukocytosis; operative findings of aortic inflammation and

Demographic findings

During the study period, 6137 patients underwent aortic reconstruction for thoracic and abdominal aneurysms. Of these patients, 43 (0.7%) fulfilled the criteria for infected aneurysms. Detailed clinical and surgical outcomes for these patients have been reported earlier. 13

From these 43 patients, our study group included the 29 patients for whom archived slides or tissue specimens were available for review. The group comprised 23 men (79%) and 6 women (21%), ranging in age from 46 to 86 years

Discussion

Infected aneurysms of the descending thoracic or abdominal aorta are rare. Here we discuss 5 topics in light of the findings of the present study: pathogenesis, risk factors for aortic infection, culture results, infecting organisms, and microscopic features.

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Citation Excerpt :
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A sum of 182 patients were included, mean age 71 years (standard deviation; SD: 8.9). The median follow-up was 50.3 months (range 0 – 360). 128 (70.3%) patients had positive blood and/or tissue culture; Staphylococcus aureus n = 38 (20.9%), Streptococcus sp. n = 37 (20.3%), Salmonella sp. n = 19 (10.4%), Enterococcus sp. n = 16 (8.8%), Gram-negative intestinal bacteria n = 6, (3.3%), Other sp. n = 12 (6.6%) and Negative cultures n = 54 (29.7%). The estimated survival for the largest groups at 2-years after surgery was: Staphylococcus aureus 62% (95% Confidence interval 53.9 – 70.1), Streptococcus sp. 74.7% (67.4 – 82.0), Salmonella sp. 73.7% (63.6 – 83.8), Enterococcus sp. 61.9% (49.6 – 74.2), and Negative cultures 89.8% (85.5 – 94.1), P = .051. There were 37 IRCs (20.3%), and 19 (51.4%) were fatal, the frequency was insignificant between the groups. The majority of IRCs, 30/37 (81%), developed during the first postoperative year.
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Original contributionsSurgical pathology of infected aneurysms of the descending thoracic and abdominal aorta: Clinicopathologic correlations in 29 cases (1976 to 1999)

Abstract

Section snippets

Patient selection

Demographic findings

Discussion

Ann Thorac Surg

J Vasc Surg

J Vasc Surg

Chest

J Vasc Surg

Eur J Vasc Surg

Am J Surg

J Vasc Surg

Ann Vasc Surg

J Vasc Surg

J Infect

Ann Vasc Surg

J Vasc Surg

J Vasc Surg

Am J Med

Eur J Vasc Endovasc Surg

J Vasc Surg

Bacterial aortitis and mycotic aneurysm of the aorta

Am J Pathol

Bland and infected arteriosclerotic aneurysmsA clinicopathologic study

Medicine

Frequency of infected aneurysms among patients in Department of Veterans Affairs hospitals, 1986–1990The role of salmonella

Mil Med

Mycotic aneurysmUncommon, but are we about to see more?

Br J Clin Pract

Mycotic aneurysms

Original contributions
Surgical pathology of infected aneurysms of the descending thoracic and abdominal aorta: Clinicopathologic correlations in 29 cases (1976 to 1999)