Mycotic Aortic Aneurysms in Dialysis Patients: Analysis of Cases

Background: Mycotic aneurysms, which are infections of major vessels, have a high, morbidity and mortality, especially those located in the aorta. The pattern of vascular calcification is different in dialysis patients. We hypothesized that aortic mycotic aneurysm carried a different clinical course in dialysis patients.
Objectives: The purpose of this study was to observe whether the clinical course of aortic mycotic aneurysms in dialysis patients differs from that of the general population.
Methods: A total of 842 hemodialysis patients and 288 peritoneal dialysis patients entered the dialysis programs between January 2001 and December 2008. All patients were reviewed for aortic mycotic aneurysms; non-infectious aortic aneurysms were excluded. Three hemodialysis patients and one peritoneal dialysis patient were found to have aortic mycotic aneurysms. The demographic data, dialysis modalities, dialysis duration, initial presentation, co-morbidities, complete blood count, biochemistry data, microbiology survey, imaging studies, treatment, and clinical outcome in these patients were retrospectively reviewed.
Results: Four patients all received at least a 5-week antibiotic treatment course. None of the patients' aneurysms ruptured. Three patients who received only medical treatment all survived the acute phase, but they all died of cardiovascular events at a mean of 163.3±101.8 days from diagnosis. Only the patient who had surgery achieved long-term survival.
Conclusion: The present observational study indicated that aortic mycotic aneurysms are rare in dialysis patients. The spontaneous rupture rate is low, even with medical therapy alone. Surgical intervention may be associated with long-term survival. The results suggest that the clinical course of aortic mycotic aneurysm is different in uremic and non-uremic patients.