Hybrid Treatment: Expanding the Armamentarium for Infected Infrarenal Abdominal Aortic and Iliac Aneursms

Abstract

PURPOSE: To investigate safety and efficacy of hybrid treatment for infected aortic and iliac aneurysms.

MATERIALS AND METHODS: Between July 2007 and May 2011, hybrid treatment was performed in 6 male patients (mean age, 67.7 y; range, 57-76 y). Hybrid treatment consisted of extraanatomic bypass (EAB) and isolation of infected aneurysm with vascular plugs. Aneurysms were divided into primary and secondary infected aneurysms. Primary infected aneurysm refers to an aneurysm arising from bacterial infection of the native arterial wall; secondary infected aneurysm refers to infection involving an aneurysm that was previously treated with graft placement.

RESULTS: The infected aneurysm involved the infrarenal abdominal aorta in 4 patients and common iliac artery in 2 patients. Hybrid treatment was successful in all 6 patients. The 3 patients with primary infected aneurysms required only hybrid treatment, whereas infected graft excision and new graft interposition was performed in 2 of the 3 patients with secondary infected aneurysms. No 30-day mortality or complications were reported. During mean follow-up of 58.6 months (range, 32.6-75.8 months), 1 patient (17%) with a secondary infected aneurysm who did not undergo additional surgery died 32.6 months after hybrid treatment from hypovolemic shock secondary to recurrent aortoenteric fistula. Cumulative survival was 100%, 100%, 83%, and 83% at 3 months, 1 year, 3 years, and 5 years.

CONCLUSIONS: Hybrid treatment appears to be a stand-alone, curative treatment for primary infected aneurysms and serves as bridge therapy to subsequent surgery for secondary infected aneurysms.