RESUMO
Infected or mycotic aneurysms (MAs) of the aorta and adjacent arteries are rare and difficult to treat. We report a unique case of a Salmonella serotype enteritidis-induced rapidly expanding aortic and iliac pseudoaneurysm during preoperative workup. Based on the presented case, we postulate that the agressive nature of Salmonella enteritidis MAs should not be underestimated. If postponed intervention is chosen and the patient is managed conservatively with antibiotic therapy to create a window of definitive diagnosis, one should consider close follow-up imaging to observe progression of the pseudoaneurysm. This may prevent the need of acute intervention.
Assuntos
Falso Aneurisma/microbiologia , Aneurisma Infectado/microbiologia , Aneurisma da Aorta Abdominal/microbiologia , Aneurisma Ilíaco/microbiologia , Infecções por Salmonella/microbiologia , Salmonella enteritidis/isolamento & purificação , Falso Aneurisma/diagnóstico por imagem , Falso Aneurisma/terapia , Aneurisma Infectado/diagnóstico por imagem , Aneurisma Infectado/terapia , Antibacterianos/uso terapêutico , Aneurisma da Aorta Abdominal/diagnóstico por imagem , Aneurisma da Aorta Abdominal/terapia , Aortografia , Implante de Prótese Vascular , Angiografia por Tomografia Computadorizada , Humanos , Aneurisma Ilíaco/diagnóstico por imagem , Aneurisma Ilíaco/terapia , Masculino , Pessoa de Meia-Idade , Infecções por Salmonella/diagnóstico por imagem , Infecções por Salmonella/terapia , Resultado do TratamentoRESUMO
BACKGROUND: Fenestration is a minimally invasive alternative for the treatment of acute symptomatic aortic dissections because it may quickly decrease the pressure gradient of the false lumen. It remains unclear where the optimal location of these fenestrations should be chosen. The purpose of this study was to study false lumen volume (FLV) after different fenestration strategies in porcine ex vivo models of aortic type B dissection. METHODS: An artificial dissection was created in ex vivo porcine aortas. A total number of 6 aortic dissection models were made. The dissection flap was divided in 3 equal parts; proximal, mid, and distal sections. In 3 models, a fenestration was made in the center of the proximal section of the dissection flap. In the 3 others in the center of the distal part of the dissection flap. The aorta was positioned in a validated in vitro circulatory system with physiological pulsatile flow. Volume measurements of true lumen volume and FLV were assessed with computed tomography. RESULTS: Performing a fenestration in the proximal part of the dissection flap resulted in FLV increase in 2 of the 3 models. Performing a fenestration in the distal part of the dissection flap resulted in FLV decrease in all 3 models. False lumen reduction was obtained significantly in the distally fenestrated models compared to the proximally fenestrated models (9.6 ± 3.5% vs. 0.7 ± 2.9%, P = 0.03). CONCLUSIONS: In this ex vivo study, we showed that distal fenestration of the false lumen in aortic dissection will result in the largest false lumen reduction.
