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Issue: Vol. 56
Section: Research Article
DOI: 10.47972/vjcts.v56i.1786
Date Published: 31/07/2026
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Lam, T. C., Ho, T. B., Ninh, Q. N. C., Nguyen, D. P., & Tran, T. V. (2026). Surgical outcomes of infective abdominal aortic aneurysm with extra-anatomic bypass and in-situ reconstruction: A single-center case series. The Vietnam Journal of Cardiovascular and Thoracic Surgery, 56, 17 - 24. https://doi.org/10.47972/vjcts.v56i.1786

Surgical outcomes of infective abdominal aortic aneurysm with extra-anatomic bypass and in-situ reconstruction: A single-center case series

Thao Cuong Lam1,2, Tat Bang Ho1, , Quoc Nguyen Chuong Ninh3, Dinh Phat Nguyen1, Thanh Vy Tran4
1 University Medical Center Ho Chi Minh city
2 School of Medicine, University of Medicine and Pharmacy at Ho Chi Minh city
3 Tay Nguyen Regional General Hospital
4 University of Medicine and Pharmacy at Ho Chi Minh city

Main Article Content

Abstract

Background: Infective (mycotic) abdominal aortic aneurysm (IAAA) is a rare but life-threatening condition with mortality rates of 20–40% even with treatment. In Southeast Asia, Salmonella spp. accounts for a disproportionate share of causative organisms compared to Western cohorts. Optimal revascularization strategy — extra-anatomic bypass (EAB) versus in-situ reconstruction (ISR) — remains debated.


Methods: We conducted a retrospective review of all patients diagnosed with IAAA and treated surgically at the Department of Thoracic and Vascular Surgery, University Medical Center Ho Chi Minh City (UMC-HCMC), between January 2022 and January 2025. Patient demographics, clinical presentation, microbiological findings, antibiotic management, operative technique, and short-term outcomes were analyzed.


Results: Four male patients underwent open surgical repair. All aneurysms were infrarenal; three were saccular and one was a pseudoaneurysm. Salmonella spp. (ESBL-negative, AmpC-negative) was identified in one patient by positive blood culture. EAB was performed in three patients using woven polyester (Dacron) grafts. ISR with a rifampicin-soaked Dacron bifurcated prosthesis was performed in one patient with extensive para-aortic abscess and concomitant duodenal perforation. All patients received targeted antibiotic therapy for 4–6 weeks postoperatively; the confirmed Salmonella case received an additional 3-month course of oral ciprofloxacin. Technical success was achieved in all four cases. There was no 30-day mortality.


Conclusions: Open surgical repair of IAAA is feasible and effective in a tertiary centre. EAB remains the preferred strategy when anatomy allows complete exclusion of the infected field. ISR may be necessary in anatomically complex cases with extensive retroperitoneal involvement. Prolonged antibiotic therapy tailored to microbiological findings is essential for both early outcomes and long-term graft preservation. A multidisciplinary approach is essential for cases with multi-organ extension.

Keywords

Infective aortic aneurysm, Mycotic aneurysm, Extra-anatomic bypass, In-situ reconstruction, Salmonella infection, Abdominal aortic aneurysm

Article Details

References

1. Sörelius K, Mani K, Björck M, et al. Endovascular treatment of mycotic aortic aneurysms: a European multicenter study. Circulation. 2014;130(24):2136–2142.
2. Müller BT, Wegener OR, Grabitz K, et al. Mycotic aneurysms of the thoracic and abdominal aorta and iliac arteries: experience with anatomic and extra-anatomic repair in 33 cases. J Vasc Surg. 2001;33(1):106–113.
3. Lin CH, Hsu RB. Primary infected aortic aneurysm: clinical presentation, pathogen, and outcome. Acta Cardiol Sin. 2014;30(6):514–521.
4. Hsu RB, Tsay YG, Wang SS, Chu SH. Surgical treatment for primary infected aneurysm of the descending thoracic aorta, abdominal aorta, and iliac arteries. J Vasc Surg. 2002;36(4):746–750.
5. Sörelius K, Budtz-Lilly J, Mani K, Wanhainen A. Systematic review of the management of mycotic aortic aneurysms. Eur J Vasc Endovasc Surg. 2019;58(3):426–435.
6. Kyriakides C, Kan Y, Kerle M, et al. 11-year experience with anatomical and extra-anatomical repair of mycotic aortic aneurysm. Eur J Vasc Endovasc Surg. 2004;27(6):585–589.
7. Oderich GS, Panneton JM, Bower TC, et al. Infected aortic aneurysms: aggressive presentation, complicated early outcome, but durable results. J Vasc Surg. 2001;34(5):900–908.
8. Hsu RB, Lin FY, Chou NK, Wang SS. Psoas abscess in patients with an infected aortic aneurysm. J Vasc Surg. 2007;46(2):230–235.
9. Wanhainen A, Van Herzeele I, Bastos Gonçalves F, et al. Editor's Choice — European Society for Vascular Surgery (ESVS) 2024 Clinical Practice Guidelines on the Management of Abdominal Aorto-Iliac Artery Aneurysms. Eur J Vasc Endovasc Surg. 2024;67(2):192–331.
10. Viet Dung et al. Mycotic Aneurysm with Iliac Artery–Colonic Fistula. Case Rep Med. 2022:3250749, 5 pages. doi:10.1155/2022/3250749.
11. Doan Quoc Hung, Le Anh Ngoc, Phung Duy Hong Son. Results of treatment of abdominal aortic and/or iliac aneurysm usingsilver graft at Vietduc university hospital. Journal of Vietnamese Cardiology. 2016;77:36–41.