Therapeutic effectiveness of tuberculous aneurysm and risk factors for mortality: a systematic review

Efficacy and Risk Factors of Sac Filling with Rifampin after Endovascular Repair for Treating Brucellosis-Associated Pseudoaneurysms

BACKGROUND

This study aimed to investigate the efficacy and independent risk factors of sac filling with rifampin after endovascular repair for treating brucellosis-associated pseudoaneurysms.

METHODS

This retrospective study included patients with brucellosis-associated pseudoaneurysms who underwent sac filling with rifampin after endovascular repair. Brucella activity was evaluated using C-reactive protein (CRP) and procalcitonin levels. The patients were followed up for 5 years. Intraoperative and postoperative complications, including paraplegia, endoleak, and stent thrombosis, and mortality were recorded. Kaplan-Meier survival curves were used to estimate the incidence of adverse events, and Cox regression analysis was performed to determine the independent risk factors for adverse events.

RESULTS

A total of 30 patients were included in this study. The procedural success rate was 90%. The mean follow-up period was 51.9 ± 2.8 months. Kaplan-Meier survival analysis revealed that the overall 1-, 3-, and 5-year event-free survival rates were 93%, 80%, and 73%, respectively. Multivariate Cox regression analysis revealed that a preoperative CRP level ≥ 33.65 mg/L and the percentage of neutrophils were independent risk factors for postoperative adverse events. Antibiotic treatment was an independent protective factor.

CONCLUSION

This study showed the efficacy of sac filling with rifampin after endovascular repair in treating brucellosis-associated pseudoaneurysm. CRP level and the percentage of neutrophils are independent risk factors for postoperative adverse events and should be considered before endovascular repair. In addition, antibiotic treatment should be provided to reduce the occurrence of postoperative adverse events.

Tuberculous aneurysm diagnosed by CT-Guided biopsy after stent graft replacement: A case report

A tuberculous aneurysm is an uncommon extrapulmonary tuberculosis and is usually fatal. The best way to treat it involves a combination of open surgery and medical treatment. However, it can be challenging to diagnose a tuberculous aneurysm. In this report, we describe a patient with a tuberculous aneurysm who was treated with stent-graft replacement and CT-guided biopsy for diagnosis, followed by nine months of anti-tuberculosis therapy. Despite one week of anti-tuberculous therapy, her fever persisted. A CT scan revealed new, well-defined nodules measuring 1-2mm in the lungs and hepatomegaly, indicating complications of miliary tuberculosis. After three weeks after the CT-guided biopsy, Mycobacterium tuberculosis grew from the arterial wall tissue, leading to the diagnosis of a tuberculous aneurysm complicated by miliary tuberculosis. The patient's aneurysm disappeared on follow-up CT scans, and the patient has been under observation for five years without a relapse. This rare case of tuberculous aneurysm can provide lessons for countries with a low prevalence of tuberculosis. This suggests the possibility of treatment with stent-graft replacement and anti-tuberculous medication and the usefulness of CT-guided biopsy for microbiological and pathological diagnosis.

Cardiac Tuberculosis: A Case Series from Ethiopia, Italy, and Uganda and a Literature Review

Extrapulmonary tuberculosis (TB) is estimated to account for up to 20% of active cases of TB disease, but its prevalence is difficult to ascertain because of the difficulty of diagnosis. Involvement of the heart is uncommon, with constrictive pericarditis being the most common cardiac manifestation. Diagnostic research for cardiac disease is frequently lacking, resulting in a high mortality rate. In addition to direct cardiac involvement, instances of cardiac events during antitubercular therapy are described. This case series describes five cases of TB affecting the heart (cardiac TB) from Italy and high-burden, low-income countries (Ethiopia and Uganda), including a case of Loeffler syndrome manifesting as myocarditis in a patient receiving antitubercular therapy. Our study emphasizes how cardiac TB, rare but important in high-burden areas, is a leading cause of pericardial effusion or pericarditis. Timely diagnosis and a comprehensive approach, including imaging and microbiological tools, are crucial. Implementing high-sensitivity methods and investigating alternative samples, such as detection of tuberculosis lipoarabinomannan or use of the GeneXpert assay with stool, is recommended in TB control programs.

Endovascular salvage of tubercular aortitis presenting as descending thoracic aortic pseudoaneurysm in association with vertebral tuberculosis

A gentleman in his late 30s presented with a history of evening rise of temperature and generalised malaise of 1-week duration. He had associated upper back pain with tingling and numbness of both lower limbs. An unexplained episode of hypotension with hemoptysis propelled a computed tomography (CT) examination of chest which was suggestive of a pseudoaneurysm of the posterior wall of descending thoracic aorta in the vicinity of the Pott's spine with a prevertebral and paravertebral abscess, for which he was referred to vascular surgeons.Tubercular involvement of vasculature is a rare disease, aortic involvement even rarer. Less than 50 cases of vertebral tuberculosis with tubercular thoracic aortic aneurysm have been reported in the medical literature, but the disease carries a colossal mortality and morbidity.After a multidisciplinary teamwork, thoracic endovascular aortic repair was done for exclusion of the aneurysmal segment, with simultaneous antitubercular and broad-spectrum antibiotic chemotherapy. The patient recuperated well.

Tuberculous Thoracic Aortic Pseudoaneurysm Associated With Spinal Tuberculosis: A Case Report and Literature Review

Background

Thoracic aortic pseudoaneurysm associated with spinal tuberculosis is a rare but fatal condition. The risk of pseudoaneurysm rupture is extremely high and this disease needs greater awareness. The present study reported a case of thoracic aortic pseudoaneurysm caused by paravertebral cold abscess with spinal tuberculosis.

Case presentation

A 35-year-old woman with back pain was diagnosed with thoracic aortic pseudoaneurysm with spinal tuberculosis, and endovascular aneurysm repair (EVAR) was performed. The patient's symptoms disappeared after EVAR, following which she was discharged.

Conclusions

The case highlighted that in cases where non-enhanced computed tomography (CT) revealed that the aortic vessel was surrounded by a paravertebral abscess, magnetic resonance imaging (MRI) should be performed to confirm whether the presence of a pseudoaneurysm. Upon diagnosis of pseudoaneurysm, surgery should be performed immediately. In recent times, EVAR has emerged as a promising alternative to open surgery.