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Over a 12-year period (1975-1987), 565 patients (male: 94.5 percent; female: 5.5 percent) underwent aorto-iliac bilateral reconstruction. The operations were performed by the same surgical team and all patients were followed up for 13 years. The patients' mean age was 59.4 years; 16.6 percent were over 70; 16 percent had a non-fissured aneurysm. The postoperative mortality rate was 2.8 percent, with relatively few deaths of cardiovascular origin (0.5 percent). The late mortality rate was significantly higher than that of an age-matched control population. Arteritis and its surgical treatment accounted for a low proportion of late deaths: 10.7 percent as opposed to other cardiovascular diseases (33 percent) and chiefly to cancer (39 percent)--a figure not found in other reports. Five percent of the patients had to be amputated soon after the operation or later; this is a low figure compared with the 33 percent of patients who had one limb threatened before reconstructive surgery. After the aorto-iliac reconstruction 81 percent of the patients remained considerably improved at 5 years and 67 percent at 10 years. Long-term arterial patency was satisfactory (95 percent at 5 years, 90 percent at 10 years). This type of surgery, therefore, benefits the patients' functions and their life: it avoids rupture of aneurysms and sedentarity due to a disabling intermittent claudication, and it considerably increases the duration of life.

A 30-year retrospective review identified 13 patients treated for infected aneurysms of the abdominal aorta or iliac arteries, for an overall incidence of 0.65%. A constellation of clinical findings led to the correct preoperative diagnosis in 11 (85%) of 13 patients. Treatment methods included resection and in situ replacement grafting in seven patients, resection and extra-anatomic bypass in five patients, and resection-ligation in one patient. Four (31%) of 13 patients died within 30 days of operation, three of whom died of rupture. Overall, good results were achieved in five patients (38%), while poor results were noted in the remaining eight patients (62%). The determinants of outcome were aneurysm location or rupture, the presence of established infection, and the virulence of the infecting organism. In 10 (77%) of the 13 aneurysms, Salmonella species, Bacteroides fragilis, Staphylococcus aureus, and Pseudomonas aeruginosa accounted for all deaths, ruptures, and suprarenal aneurysm infections. These data suggest that patients with primary infections of the abdominal aorta or iliac arteries continue to present with advanced infections or aneurysm rupture that result in a high mortality.