Infected abdominal aortic aneurysm is uncommon, but it has a grave prognosis. We report a case of infected abdominal aortic aneurysm with localized dissection that was preoperatively given antibiotics for 1 month, followed by an anatomical vascular reconstruction with a prosthetic graft wrapped with a pedicled omental flap. A 48-year-old man with uncontrolled diabetis mellitus was admitted with fever, appetite loss, and pulsating abdominal pain. Abdominal CT revealed a saccular aneurysmal change in the infrarenal aorta and weakly enhanced surrounding soft tissue density. Two lumens were clearly enhanced in the aneurysm. Klebsiella pneumoniae infection was diagnosed on the basis of blood culture. Pathologically, suppurative inflammation was confirmed in the surrounding tissue and dissection of the media of the saccular aneurysmal wall was indicated. After administration of antibiotics for 1 month, both clinical and laboratory indications of inflammatory reaction improved. The aneurysm was then almost completely resected and replaced with a Y-shaped prosthetic graft covered with a pedicled omental flap. The postoperative course was uneventful. After surgery, antibiotics were administered for 3 more months. The patient is now surviving and has no symptoms 6 months after operaion. Complete removal of the infected lesion and long-term follow-up with antibiotic chemotherapy are important for this situation.

A 24-year-old woman with patent ductus arteriosus underwent division of the ductus. On the fifth postoperative day (POD 5), MRSA was detected in pus from the wound. On POD 8, an emergency operation was performed for left tension hemothorax due to a ruptured aorta with MRSA infection. The bleeding site in the descending aorta was covered with a viable omental flap under deep hypothermic circulatory arrest. Although MRSA was detected in the pleural effusion and the aortic wall, the patient recovered from pyothorax, and pneumonia caused by Pseudomonas aeruginosas and acute renal failure. On POD 37, a pseudoaneurysm of the descending aorta was found and graft replacement was performed on POD 56 due to enlargement of the aneurysm. However, MRSA was not detected in the left pleural effusion. The postoperative course was uneventful. Omental transfer should be considered for the treatment of severe aortic wall infection, even in the presense of MRSA infection.

To avoid homologous blood transfusion, the effectiveness of autologous blood predonation was evaluated in patients with elective abdominal aortic aneurysm (AAA) repair. From January 1993 to July 1996, 53 patients underwent Y graft replacement by using autologous rapid transfusion device AT1000^® (Electromedics. Inc, Englewood, CO). The patients were devided in to 3 groups. Thirty one patients had no blood donation (Group A). Twelve patients had 400ml blood donation with administration of an iron preparation (Group B). Ten patients donated the same amount of blood as those in Group B, with administration of both an iron preparation and recombinant human erythropoietin (rHuEPO) (Group C). There were no significant differences in terms of age, gender, operating time, intraoperative bleeding, and total amount of homologous and autologous blood transfusion in the 3 groups. In Group A, the mean volume of homologous blood transfusion was 250±370ml and in both Groups B and C, no homologous blood was required and 400ml autologous blood was used. Homologous blood transfusion was avoided in 58.9 (18/31) of patients in Group A and all of the patients in Groups B and C. Due to the blood predonation prior to surgery, a hemoglobin level decreased significantly at the time of operation in Group B (without rHuEPO), but in Group C (with rHuEPO) the hemoglobin level was kept constant. During the first postoperative week, the minimum hemoglobin level in Group C was significantly higher than in the other groups. In conclusion, by donating 400ml autologous blood before surgery and using an intraoperative autotransfusion system, homologous blood transfusion could be avoided in elective AAA repair. With rHuEPO, the hemoglobin level could be maintained, despite predonation and intraoperative blood loss.