Fibrinólisis sistémica exitosa en un paciente con endocarditis bacteriana / Successful endovenous fibrinolysis in a patient with bacterial endocarditis

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Aneurismas micóticos: particularidades diagnósticas y de tratamiento / Mycotic aneurysms: Diagnostic and treatment characteristics

Los aneurismas infecciosos, pese a su escasa prevalencia, suponen un desafio para el cirujano vascular que se enfrenta a ellos, dado que el diagnóstico precisa de un índice de sospecha muy elevado, habitualmente ante un paciente comprometido con sepsis, rotura arterial y localizaciones atípicas. Son cuadros que no permitan normalmente la simple escisión como tratamiento satisfactorio, que se mantiene actualmente en controversia. Se realiza una discusión acerca de los métodos diagnósticos y los tratamientos más contrastados, incluyendo el manejo endovascular

Infected aneurysms, despite their low prevalence, are a great challenge for the vascular surgeon. Thus, its diagnosis is made under a high index of suspicion, usually when faced with septic patient with arterial rupture located in atypical sites. Their treatment still remains controversial as there is no single or simple treatment. The most well-known diagnostic methods and treatments are discussed, including the endovascular point of view

Scedosporium prolificans pericarditis and mycotic aortic aneurysm in a lung transplant recipient receiving voriconazole prophylaxis.

Despite the adoption of antifungal prophylaxis, fungal infections remain a significant concern in lung transplant recipients. Indeed, some concern exists that such prophylaxis may increase the risk of infection with drug-resistant fungal organisms. Here, we describe a case of disseminated Scedosporium prolificans infection, presenting as pericarditis, which developed in a lung transplant patient receiving prophylactic voriconazole for 8 months. The epidemiology and clinical presentation of S. prolificans infections are reviewed, and controversies surrounding antifungal prophylaxis and the development of resistant infections are discussed.

Infection of a chronically implanted iliac artery stent.

Pseudoaneurysm formation and infection at the site of iliac artery stenting are uncommon complications that occur soon after stent placement. We describe a case in which an infected pseudoaneurysm developed 22 months following stent implantation. Stent infection, although rare, has potentially disastrous implications, as made evident by a review of the literature. Prophylactic antibiotic therapy at the time of stent placement is recommended.

Mycotic aneurysms in transplant patients.

Eight cases of mycotic aneurysm occurred in seven transplant patients. Perinephric wound infection involving the iliac arteries was the cause of at least seven aneurysms. Simple ligation of the iliac artery proximal and distal to the aneurysm without grafting was effective therapy in all but one patient with an aortic aneurysm who required an axillofemoral bypass graft prior to excision of the aneurysm. There were no instances of ischemia to the involved extremities, and only two patients died as a result of the aneurysm. This dangerous complication can be avoided by preventing wound infections. In established perinephric abscesses, the kidney should be removed and the wound kept as clean as possible in order to prevent this complication. Arteriograms may be useful in the early detection of these aneurysms, before they rupture.