ABSTRACT
Infected thoracic aortic aneurysms are rare. Standard treatment methods have not yet been established for medical treatment, timing of surgery, or surgical techniques. In this study, we report a case in which an ascending aortic reconstruction using an autologous superficial femoral artery was successfully performed for an infected pseudoaneurysm of the thoracic aorta without the use of artificial materials. The patient was a 78-year-old man with bacteremia caused by Staphylococcus aureus and an infected pseudoaneurysm of the thoracic aorta. The patient underwent replacement of the ascending aorta and coronary artery bypass grafting. The patient was discharged from the hospital with no recurrence of infection and no abnormality of the reconstructed aorta.
ABSTRACT
Resumo Aneurismas infecciosos, anteriormente chamados de aneurismas micóticos, são raros; acometem com maior frequência a aorta de pacientes jovens e apresentam maior tendência à rotura do que aneurismas de outras etiologias. O formato sacular é o mais característico, e os agentes etiológicos mais comuns são Staphylococcus sp e Salmonella sp. A literatura fornece informações limitadas e imprecisas sobre a correta nomenclatura, diagnóstico e tratamento da doença. Os autores reuniram três casos cujos procedimentos diagnósticos e terapêuticos foram documentados. Além de relatar essa série de casos, realiza-se uma revisão sobre o tema, a fim de estabelecer estratégias diagnósticas e terapêuticas pertinentes.
Abstract Infectious aneurysms, formerly known as mycotic aneurysms, are rare, most often involve the aorta in young patients, and have a greater tendency to rupture than aneurysms of other etiologies. The most characteristic shape is saccular and the most common etiologic agents are Staphylococcus sp. and Salmonella sp. There is scant and imprecise information in the literature about correct nomenclature, diagnosis, and treatment. The authors present three cases in which diagnostic and therapeutic procedures were documented. In addition to reporting this case series, the authors also present a review of the subject, outlining pertinent diagnostic and therapeutic strategies.
Subject(s)
Humans , Male , Adult , Middle Aged , Aneurysm, Infected/surgery , Aneurysm, Infected/diagnosis , Aortic Aneurysm, Abdominal/surgery , Aortic Aneurysm, Abdominal/diagnosis , Aortic Aneurysm/drug therapy , Aneurysm, Infected/drug therapy , Anti-Bacterial Agents/therapeutic useABSTRACT
Resumen Introducción: Los aneurismas infecciosos constituyen una patología poco frecuente y se caracterizan por presentar infección de la pared del vaso implicado. El mejor tratamiento no está definitivamente establecido. Objetivo: Describir un caso de aneurisma infeccioso con manejo endovascular. Caso clínico: Presentamos un paciente de sexo masculino de 75 años que ingresa por cuadro compatible con abdomen agudo y que en el posoperatorio se pesquisa un aneurisma infeccioso del tronco celíaco, el cual se trata mediante una endoprótesis y manejo antibiótico. Discusión: El manejo tradicional del aneurisma infeccioso es la cirugía abierta que incluye la extirpación o exclusión del aneurisma y de su tejido perivascular infectado, pero conlleva gran morbimortalidad. Conclusión: El aneurisma infeccioso puede ser manejado de forma mínimamente invasiva con técnica endovascular, con baja morbilidad inmediata, pero con resultados a largo plazo aun no concluyentes.
Introduction: Infectious aneurysms are a rare disease and are characterized by infection of the involved vessel wall. The best treatment is definitely not established. Aim: To describe a case of infectious aneurysm with endovascular management. Case report: We present a 75-year-old male patient admitted to a table compatible with acute abdomen and that an infectious aneurysm of the celiac trunk is investigated in the postoperative period, treated with an endoprosthesis and antibiotic management. Discussion: The traditional management of the infectious aneurysm is open surgery that includes the removal or exclusion of the aneurysm and its infected perivascular tissue, but it leads to great morbidity and mortality. Conclusion: The infectious aneurysm can be managed minimally invasively with endovascular technique, with immediate low morbidity, but with long-term results that are still inconclusive.
Subject(s)
Humans , Male , Aged , Aneurysm, Infected/diagnosis , Aneurysm, Infected/therapy , Endovascular Procedures/methods , Liver Abscess/complications , Prostheses and Implants , Angiography , Tomography, X-Ray Computed , Treatment Outcome , Minimally Invasive Surgical Procedures , Abdomen, Acute/etiology , Liver Abscess/diagnosisABSTRACT
Bacillus Calmette-Guérin (BCG) intravesical instillation therapy for bladder cancer is accepted as an effective treatment, and infectious complications are rare. We present a case report on a patient with a common iliac pseudoaneurysm and a recurrent mycotic thoracoabdominal aortic aneurysm, who had a history of previous BCG therapy for bladder cancer. A 64-year-old man underwent emergency graft interposition of the right common iliac artery due to a ruptured pseudoaneurysm. Nine months after initial surgery, a biopsy of the pelvic retroperitoneal collection revealed epithelioid granuloma with caseous necrosis. Ziehl-Neelsen stain and mycobacterial culture were positive for acid-fast bacilli, which was identified as BCG (Tokyo 172). Diagnosis of BCG infection was delayed because of lack of clear clinical evidence of persistent infection. After 6 months of antituberculous chemotherapy the patient underwent resection of the mycotic thoracoabdominal aortic aneurysm and <i>in situ </i>reconstruction with a branched Dacron graft soaked in rifampicin because of its rapid growth. The pathological diagnosis was infectious aneurysm with sclerosis and epithelioid granuloma, however, acid-fast stain and culture were negative. Nine months later CT showed no recurrence of infectious aneurysm. Because the clinical presentation of BCG mycotic aneurysm is different from bacterial or fungal mycotic aneurysm, diagnosis by means of medical history checking and clinical presentation, in addition to surgical and medical combined treatment are important for its management.
ABSTRACT
A 58-year-old man who underwent mitral valve replacement for mitral valve prolapse that was complicated by severe mitral regurgitation was referred to our department due to his sudden onset of drowsiness. Brain computed tomography revealed a hemorrhage in the anterior interhemispheric fissure and left frontal lobe. Cerebral angiography demonstrated a saccular aneurysm at the angular branch of the middle cerebral artery (MCA), but there was no evidence of vascular abnormalities at the hemorrhagic area. End-to-end anastomosis of the angular branch was performed after resection of the friable aneurysm and the perianeurysmal parent artery segment. Follow-up cerebral angiography after three weeks showed an aneurysm in the distal anterior cerebral artery (ACA) in the previously hemorrhagic area. This ruptured aneurysm was successfully clipped. An infectious aneurysm was confirmed on the histopathological examination.
Subject(s)
Humans , Middle Aged , Aneurysm , Aneurysm, Ruptured , Anterior Cerebral Artery , Arteries , Brain , Cerebral Angiography , Follow-Up Studies , Frontal Lobe , Hemorrhage , Middle Cerebral Artery , Mitral Valve , Mitral Valve Insufficiency , Mitral Valve Prolapse , Parents , Sleep StagesABSTRACT
Infectious intracranial aneurysm, so-called mycotic aneurysm, has been rarely reported after era of antibiotics. Infective endocarditis is the most common cause. It is commonly occurs in patients with valvular heart disease. The authors report a case of infectious intracranial aneurysm in the distal branch of the right middle cerebral artery with embolic cerebral infarction in the contralateral middle cerebral artery territory. The patient underwent surgical excision of the aneurysm after six weeks of antibiotics therapy. The pathological findings demonstrated severe inflammatory change in the adventitial layer but intact intimal layer. The clinical features and the pathogenesis is discussed with review of pertinent literature.