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Ron-bin Hsu - One of the best experts on this subject based on the ideXlab platform.
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primary Infected aortic Aneurysm clinical presentation pathogen and outcome
Acta Cardiologica Sinica, 2014Co-Authors: Cheng Hsin Lin, Ron-bin HsuAbstract:Purpose: Infected Aneurysm of the aorta and adjacent arteries is rarely occurring and can be fatal without surgical intervention. Within the medical community, the most efficacious treatment strategy to address Infected aortic Aneurysm remains controversial. In this study, we have reviewed our treatment experience with 109 patients. Methods: We included in our study all consecutive patients treated for primary Infected aortic Aneurysm at our facility between 1995 and 2011. Aneurysm-related mortality was defined as the presence of in-hospital and late mortality related to infection or postoperative complications. Results: The median patient age was 72 years (range, 35-88), and 87 (80%) were male. Pathogen was isolated in 101 patients, and the most common microorganism identified was non-typhoid ＂Salmonella＂ in 61 (60%), followed by ＂Staphylococcus＂ aureus in 16 (16%) and ＂Streptococci＂ species in 7 (7%). Eighty-five (78%) patients underwent surgical treatment. Surgery included open repair with in-situ graft replacement in 77 (71%) and endovascular repair in 8 (7%). The Aneurysm-related mortality rate was 67% in medically treated and 21% in surgically treated patients, with a median follow-up duration of 31.5 months (range 1-189). Additionally, risk factors for Aneurysm related mortality included old age, chronic lung disease, psoas muscle abscess, short duration of preoperative antibiotics, no operation, and probably endovascular repair. Conclusions: Non-typhoid Salmonella was the most common pathogen found in our study group patients with Infected aortic Aneurysm. It appears that prolonged preoperative antibiotic treatment followed by open in-situ graft replacement remains the preferred and most effective treatment strategy.
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Infected Aneurysms of the suprarenal abdominal aorta.
Journal of vascular surgery, 2011Co-Authors: Ron-bin Hsu, Chung-i Chang, Chih-yang ChanAbstract:Background Infected Aneurysm of the suprarenal abdominal aorta is rare and can be fatal without surgery. There have been only sporadic case reports or small case series. We review our experience with 14 patients over 13 years. Methods Retrospective chart review. Results Between 1997 and 2010, 14 cases of Infected Aneurysms of the suprarenal abdominal aorta were treated at our hospital. There were 11 men with median age of 75.5 years (range, 35-88). Of the 13 pathogens isolated, the most common responsible microorganism was nontyphoid Salmonella in eight (62%) followed by Staphylococcus aureus in three (23%) and Streptococcus in two patients (15%). At the first admission, six patients had medical treatment alone, five patients underwent early open in situ graft repair, and three patients underwent hybrid endovascular stenting and visceral debranching. Of the six medically treated patients, two patients died in the hospital because of Aneurysm rupture, and two patients underwent late open in situ graft repair because of Aneurysm progression or rupture. Of the five open surgically treated patients, one patient died in the hospital because of nosocomial sepsis, and four patients were alive without major postoperative complication. Of the three endovascularly treated patients, one patient died in the hospital because of intestinal ischemia, one patient died 6 months later because of postoperative complication, and one patient was alive with complications of paraplegia, renal failure, and permanent dialysis. The Aneurysm-related mortality rate was 33% (2/6) in medical treatment alone, 20% (1/5) in open in situ grafting, and 67% (2/3) in hybrid endovascular stenting. Conclusions Infected Aneurysm of the suprarenal abdominal aorta was rare. Nontyphoid Salmonella was the most common responsible microorganism. Open in situ graft repair remained a preferred and durable treatment strategy.
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Selective medical treatment of Infected Aneurysms of the aorta in high risk patients.
Journal of vascular surgery, 2008Co-Authors: Ron-bin Hsu, Chung-i Chang, Fang-yue LinAbstract:Background Infected Aneurysm of the aorta is almost always fatal without undergoing aortic resection. Medical treatment was attempted selectively in patients who were considered too high risk for surgery. We review our experience with 22 patients treated without undergoing aortic resection over 12 years. Methods Retrospective chart review. Results Between 1995 and 2007, 22 cases of Infected aortic Aneurysms treated without undergoing aortic resection during the first admission were included. There were 17 men with a median age of 76 years (range, 35 to 88 years). Of 18 pathogens isolated, the most common responsible microorganism was nontyphoid Salmonella in 11 followed by Staphylococcus aureus in five. The site of infection was thoracic in eight and abdominal in 14. The hospital mortality rate was 50%, and the Aneurysm-related mortality rate after long-term follow-up was 59%. The event-free survival rate at one year was 32%. Of 11 patients with Salmonella infection, eight patients have lived beyond 30 days and six were event-free after one year. Of 11 patients with non-Salmonella, four patients have lived beyond 30 days and only one was event-free after one year. The overall Aneurysm-related mortality rate was 36% in Salmonella Infected patients and 82% in non-Salmonella Infected patients. Conclusion Clinical results of medical treatment using current antibiotics in patients with Infected aortic Aneurysm were poor. Traditional surgical excision of Infected aortic Aneurysms with revascularization remains the gold standard and should be attempted except in high risk patients.
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Infected Aneurysm of the thoracic aorta.
Journal of vascular surgery, 2008Co-Authors: Ron-bin Hsu, Fang-yue LinAbstract:Background Infected Aneurysm of the thoracic aorta is rare and can be fatal without surgical treatment. We review our experience with 32 patients during a 12-year period. Methods Retrospective chart review. Results Between 1995 and 2007, 32 patients (24 men, 8 women) with Infected Aneurysms of thoracic aorta were treated at our hospital. Their median age was 74 years (range, 50-88 years). Of the 28 pathogens isolated, the most common responsible microorganism was nontyphoid Salmonella in 16 (57%), followed by Staphylococcus aureus in four (14%) and Mycobacterium tuberculosis in three (11%). The site of infection was the aortic arch in 13 patients, proximal descending thoracic aorta in 10, and distal descending thoracic aorta in 9. Seven patients had medical treatment alone, and 25 patients underwent in situ graft replacement. The hospital mortality rate of medical treatment alone was 57%, and the hospital mortality rate of in situ grafting was 12%. Of the 22 operated-on survivors, there were 11 late deaths, four of which were Aneurysm-related. The Aneurysm-related mortality rate in operated-on patients was 28%. Of 16 patients with infection caused by nontyphoid Salmonella , 13 patients underwent in situ grafting, with a hospital mortality rate of 8% and Aneurysm-related mortality rate of 31%. Conclusions Infected Aneurysm of the thoracic aorta was uncommon. The clinical results of in situ grafting were improving. Nontyphoid Salmonella was the most common responsible microorganism, and the prognosis of infection caused by Salmonella was not dismal. Outcomes of other management strategies, such as endovascular stenting, need to be compared with these results.
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surgery for Infected Aneurysm of the aortic arch
The Journal of Thoracic and Cardiovascular Surgery, 2007Co-Authors: Ron-bin Hsu, Fang-yue LinAbstract:Objective Infected Aneurysm of the aortic arch is rare and can be fatal without surgery. We report our surgical experience with Infected Aneurysms of the aortic arch. Method We conducted a retrospective chart review. Results Between 1995 and 2006, 10 patients with Infected Aneurysms of the aortic arch were treated at our hospital. There were 8 men with a median age of 67.5 years (range, 50–79 years). The most common pathogen was nontyphoid Salmonella in 5 (50%) patients, followed by Staphylococcus aureus in 2 patients. The site of infection was the aortic arch at the level of the brachiocephalic artery in 1, the left common carotid artery in 4, and the left subclavian artery in 5 patients. All patients underwent in situ graft replacement under deep hypothermic circulatory arrest. There was 1 (10%) hospital death because of persistent infection. Major postoperative complications occurred in 7 (70%) patients, with hypoxic encephalopathy occurring in 4 patients. Late prosthetic graft infection occurred in 1 patient, who died of massive gastrointestinal bleeding 4 months after the operation. Of the 9 patients with distal arch Aneurysms, 3 were operated on through a sternotomy with a hospital mortality rate of 33% and an Aneurysm-related mortality rate of 67%. The operation was performed through a thoracotomy in 6 patients, with no hospital mortality and an Aneurysm-related mortality rate of 17%. Conclusions Infected aortic arch Aneurysm was uncommon and nontyphoid Salmonella was the most common pathogen. Current treatment with in situ graft replacement was associated with high mortality and morbidity. Improvements in cerebral protection and surgical techniques should improve patient outcome.
Fang-yue Lin - One of the best experts on this subject based on the ideXlab platform.
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Selective medical treatment of Infected Aneurysms of the aorta in high risk patients.
Journal of vascular surgery, 2008Co-Authors: Ron-bin Hsu, Chung-i Chang, Fang-yue LinAbstract:Background Infected Aneurysm of the aorta is almost always fatal without undergoing aortic resection. Medical treatment was attempted selectively in patients who were considered too high risk for surgery. We review our experience with 22 patients treated without undergoing aortic resection over 12 years. Methods Retrospective chart review. Results Between 1995 and 2007, 22 cases of Infected aortic Aneurysms treated without undergoing aortic resection during the first admission were included. There were 17 men with a median age of 76 years (range, 35 to 88 years). Of 18 pathogens isolated, the most common responsible microorganism was nontyphoid Salmonella in 11 followed by Staphylococcus aureus in five. The site of infection was thoracic in eight and abdominal in 14. The hospital mortality rate was 50%, and the Aneurysm-related mortality rate after long-term follow-up was 59%. The event-free survival rate at one year was 32%. Of 11 patients with Salmonella infection, eight patients have lived beyond 30 days and six were event-free after one year. Of 11 patients with non-Salmonella, four patients have lived beyond 30 days and only one was event-free after one year. The overall Aneurysm-related mortality rate was 36% in Salmonella Infected patients and 82% in non-Salmonella Infected patients. Conclusion Clinical results of medical treatment using current antibiotics in patients with Infected aortic Aneurysm were poor. Traditional surgical excision of Infected aortic Aneurysms with revascularization remains the gold standard and should be attempted except in high risk patients.
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Infected Aneurysm of the thoracic aorta.
Journal of vascular surgery, 2008Co-Authors: Ron-bin Hsu, Fang-yue LinAbstract:Background Infected Aneurysm of the thoracic aorta is rare and can be fatal without surgical treatment. We review our experience with 32 patients during a 12-year period. Methods Retrospective chart review. Results Between 1995 and 2007, 32 patients (24 men, 8 women) with Infected Aneurysms of thoracic aorta were treated at our hospital. Their median age was 74 years (range, 50-88 years). Of the 28 pathogens isolated, the most common responsible microorganism was nontyphoid Salmonella in 16 (57%), followed by Staphylococcus aureus in four (14%) and Mycobacterium tuberculosis in three (11%). The site of infection was the aortic arch in 13 patients, proximal descending thoracic aorta in 10, and distal descending thoracic aorta in 9. Seven patients had medical treatment alone, and 25 patients underwent in situ graft replacement. The hospital mortality rate of medical treatment alone was 57%, and the hospital mortality rate of in situ grafting was 12%. Of the 22 operated-on survivors, there were 11 late deaths, four of which were Aneurysm-related. The Aneurysm-related mortality rate in operated-on patients was 28%. Of 16 patients with infection caused by nontyphoid Salmonella , 13 patients underwent in situ grafting, with a hospital mortality rate of 8% and Aneurysm-related mortality rate of 31%. Conclusions Infected Aneurysm of the thoracic aorta was uncommon. The clinical results of in situ grafting were improving. Nontyphoid Salmonella was the most common responsible microorganism, and the prognosis of infection caused by Salmonella was not dismal. Outcomes of other management strategies, such as endovascular stenting, need to be compared with these results.
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surgery for Infected Aneurysm of the aortic arch
The Journal of Thoracic and Cardiovascular Surgery, 2007Co-Authors: Ron-bin Hsu, Fang-yue LinAbstract:Objective Infected Aneurysm of the aortic arch is rare and can be fatal without surgery. We report our surgical experience with Infected Aneurysms of the aortic arch. Method We conducted a retrospective chart review. Results Between 1995 and 2006, 10 patients with Infected Aneurysms of the aortic arch were treated at our hospital. There were 8 men with a median age of 67.5 years (range, 50–79 years). The most common pathogen was nontyphoid Salmonella in 5 (50%) patients, followed by Staphylococcus aureus in 2 patients. The site of infection was the aortic arch at the level of the brachiocephalic artery in 1, the left common carotid artery in 4, and the left subclavian artery in 5 patients. All patients underwent in situ graft replacement under deep hypothermic circulatory arrest. There was 1 (10%) hospital death because of persistent infection. Major postoperative complications occurred in 7 (70%) patients, with hypoxic encephalopathy occurring in 4 patients. Late prosthetic graft infection occurred in 1 patient, who died of massive gastrointestinal bleeding 4 months after the operation. Of the 9 patients with distal arch Aneurysms, 3 were operated on through a sternotomy with a hospital mortality rate of 33% and an Aneurysm-related mortality rate of 67%. The operation was performed through a thoracotomy in 6 patients, with no hospital mortality and an Aneurysm-related mortality rate of 17%. Conclusions Infected aortic arch Aneurysm was uncommon and nontyphoid Salmonella was the most common pathogen. Current treatment with in situ graft replacement was associated with high mortality and morbidity. Improvements in cerebral protection and surgical techniques should improve patient outcome.
Kyoko Yokota - One of the best experts on this subject based on the ideXlab platform.
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Infective endocarditis and Infected Aneurysm caused by Streptococcus dysgalactiae subsp. equisimilis: a case report.
Clinical case reports, 2017Co-Authors: Naoki Watanabe, Shuji Bandoh, Tomoya Ishii, Kiyoshi Negayama, Norimitsu Kadowaki, Kyoko YokotaAbstract:Endocarditis caused by Streptococcus dysgalactiae subsp. equisimilis (SDSE) is rare. Infected Aneurysm is one of the most serious complications of infective endocarditis. However, no reports have described SDSE-related Infected Aneurysm. We herein report a successfully treated case of SDSE-associated infective endocarditis with an Infected Aneurysm.
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Infective endocarditis and Infected Aneurysm caused by Streptococcus dysgalactiae subsp. equisimilis: a case report.
Clinical Case Reports, 2017Co-Authors: Naoki Watanabe, Shuji Bandoh, Tomoya Ishii, Kiyoshi Negayama, Norimitsu Kadowaki, Kyoko YokotaAbstract:Key Clinical Message Endocarditis caused by Streptococcus dysgalactiae subsp. equisimilis (SDSE) is rare. Infected Aneurysm is one of the most serious complications of infective endocarditis. However, no reports have described SDSE-related Infected Aneurysm. We herein report a successfully treated case of SDSE-associated infective endocarditis with an Infected Aneurysm.
S H Chu - One of the best experts on this subject based on the ideXlab platform.
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surgical treatment for primary Infected Aneurysm of the descending thoracic aorta abdominal aorta and iliac arteries
Journal of Vascular Surgery, 2002Co-Authors: Ron-bin Hsu, Yeouguang Tsay, Shoeishen Wang, S H ChuAbstract:Abstract Objective and Method: In this retrospective review, we report the surgical results of Infected aortic Aneurysms treated at a single center over 5 years. Results: From October 1996 to October 2001, 19 patients with Infected aortic Aneurysm were treated with surgery, nine with suprarenal infections (four proximal descending thoracic aortic Aneurysms, two distal descending thoracic aortic Aneurysms, and three suprarenal abdominal aortic Aneurysms) and 10 with infrarenal infections (eight infrarenal abdominal aortic Aneurysms and two iliac artery Aneurysms). All had a positive blood or tissue culture; 89% were febrile, 89% had leukocytosis, and 32% were hemodynamically unstable. The most common responsible pathogens were Salmonella organisms (74%) followed by Streptococcus species (11%). Nine of 10 infrarenal infections were caused by Salmonella organisms. Both infrarenal and suprarenal infections were treated with wide debridement of Infected aorta, in situ prosthetic graft or patch repair, and prolonged intravenous antibiotics. Hospital survival rate was 95%: 100% for infrarenal and 89% for suprarenal infections. There was no perioperative intestinal ischemia or perioperative limb loss. Acute renal failure occurred in two patients with suprarenal infection. Late deaths have occurred in three patients with one early graft infection (5%) resulting in the only one in-hospital death at 4 months. Sixteen patients remain alive at mean follow-up of 17.8 months (range, 4-47 months). There have been no late aortic or graft infections. During the same period, there were five unoperated patients, four of whom died of shock during hospitalization. Conclusions: Infected aortic Aneurysm is common in Taiwan, and Salmonella species were the most common responsible microorganisms. With surgical intervention and prolonged intravenous antibiotics, in situ graft replacement provided a good outcome. The incidence of prosthetic graft infection was low, even in patients with infections due to Salmonella species and with in situ graft replacement. (J Vasc Surg 2002;36:746-50.)
Michael G Rowe - One of the best experts on this subject based on the ideXlab platform.
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Infected splenic artery Aneurysm with associated splenic abscess formation secondary to bacterial endocarditis case report and review of the literature
Journal of Vascular Surgery, 2007Co-Authors: Robert A Mccready, Ann M Bryant, John W Fehrenbacher, Michael G RoweAbstract:Infected Aneurysms are rare and may present with rupture or sepsis. Surgical treatment is often required to prevent catastrophic sequelae. Bacterial endocarditis is one of the classic causes of Infected Aneurysm. We present a case of a 6.1-cm Infected splenic artery Aneurysm secondary to endocarditis. Surgical treatment consisted of aortic and mitral valve replacements, splenic artery Aneurysm resection, and splenectomy. We reviewed five other reported Infected splenic artery Aneurysms in which documented ruptured had occurred in three patients. Because the rate of rupture in these patients appears to be quite high, Infected splenic artery Aneurysms require prompt treatment.