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Luo MY, Zhang X, Fang K, Guo YY, Chen D, Lee JT, Shu C. Endovascular aortic arch repair with chimney technique for pseudoaneurysm. BMC Cardiovasc Disord 2023; 23:86. [PMID: 36782127 PMCID: PMC9926684 DOI: 10.1186/s12872-023-03091-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2022] [Accepted: 01/24/2023] [Indexed: 02/15/2023] Open
Abstract
BACKGROUND Aortic pseudoaneurysm is a life-threatening clinical condition, and thoracic endovascular aortic repair (TEVAR) has been reported to have a relatively satisfactory effect in aortic pathologies. We summarized our single-centre experience using chimney TEVAR for aortic arch pseudoaneurysms with inadequate landing zones. METHODS A retrospective study was conducted from October 2015 to August 2020, 32 patients with aortic arch pseudoaneurysms underwent chimney TEVAR to exclude an aortic lesion and reconstruct the supra-aortic branches, including 3 innominate artery, 12 left common carotid arteries and 29 left subclavian arteries. Follow-up computed tomography was suggested before discharge; at 3, 6, 12 months and yearly thereafter. RESULTS The median age of 32 patients was 68.0 years (range, 28-81) with the mean max diameter of aneurysm of 47.9 ± 12.0 mm. Forty-four related supra-aortic branches were well preserved, and the technical success rate was 100%. The Type Ia endoleaks occurred in 3 (9%) patients. Two patients were lost to follow-up and 4 patients died during the follow-up period. The mean follow-up times was 46.5 ± 14.3 months. One patient died due to acute myocardial infarction just 10 days after chimney TEVAR and the other 3 patients passed away at 1.5 months, 20 months, and 31 months with non-aortic reasons. The 4.5-year survival estimate was 84.4%. The primary patency rate of the target supra-arch branch vessels was 97.7% (43/44), and no other aorta-related reinterventions and severe complications occurred. CONCLUSION For aortic arch pseudoaneurysms with inadequate landing zones for TEVAR, the chimney technique seems to be feasible, with acceptable mid-term outcomes, and it could serve as an alternative minimally invasive approach to extend the landing zone. Slow flow type Ia endoleak could be treated conservatively after chimney TEVAR. Additional experience is needed, and the long-term durability of chimney TEVAR requires further follow-up.
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Affiliation(s)
- Ming-yao Luo
- grid.506261.60000 0001 0706 7839State Key Laboratory of Cardiovascular Disease, Center of Vascular Surgery, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, No.167, Beilishi Road, Xicheng District, Beijing, 100037 China ,grid.285847.40000 0000 9588 0960Department of Vascular Surgery, Fuwai Yunnan Cardiovascular Hospital, Affiliated Cardiovascular Hospital of Kunming Medical University, Kunming, 650102 China
| | - Xiong Zhang
- grid.506261.60000 0001 0706 7839State Key Laboratory of Cardiovascular Disease, Center of Vascular Surgery, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, No.167, Beilishi Road, Xicheng District, Beijing, 100037 China ,grid.452708.c0000 0004 1803 0208Department of Vascular Surgery, The Second Xiangya Hospital of Central South University, Changsha, 410013 China
| | - Kun Fang
- grid.506261.60000 0001 0706 7839State Key Laboratory of Cardiovascular Disease, Center of Vascular Surgery, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, No.167, Beilishi Road, Xicheng District, Beijing, 100037 China
| | - Yuan-yuan Guo
- grid.285847.40000 0000 9588 0960Department of Vascular Surgery, Fuwai Yunnan Cardiovascular Hospital, Affiliated Cardiovascular Hospital of Kunming Medical University, Kunming, 650102 China
| | - Dong Chen
- grid.506261.60000 0001 0706 7839State Key Laboratory of Cardiovascular Disease, Center of Vascular Surgery, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, No.167, Beilishi Road, Xicheng District, Beijing, 100037 China
| | - Jason T. Lee
- grid.168010.e0000000419368956Department of Surgery, Stanford University School of Medicine, Stanford, CA 94305 USA
| | - Chang Shu
- State Key Laboratory of Cardiovascular Disease, Center of Vascular Surgery, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, No.167, Beilishi Road, Xicheng District, Beijing, 100037, China. .,Department of Vascular Surgery, The Second Xiangya Hospital of Central South University, Changsha, 410013, China.
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Cardiovascular Involvement in Tuberculosis: From Pathophysiology to Diagnosis and Complications-A Narrative Review. Diagnostics (Basel) 2023; 13:diagnostics13030432. [PMID: 36766543 PMCID: PMC9914020 DOI: 10.3390/diagnostics13030432] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Revised: 01/18/2023] [Accepted: 01/23/2023] [Indexed: 01/27/2023] Open
Abstract
Although primarily a lung disease, extra-pulmonary tuberculosis (TB) can affect any organ or system. Of these, cardiovascular complications associated with disease or drug toxicity significantly worsen the prognosis. Approximately 60% of patients with TB have a cardiovascular disease, the most common associated pathological entities being pericarditis, myocarditis, and coronary artery disease. We searched the electronic databases PubMed, MEDLINE, and EMBASE for studies that evaluated the impact of TB on the cardiovascular system, from pathophysiological mechanisms to clinical and paraclinical diagnosis of cardiovascular involvement as well as the management of cardiotoxicity associated with antituberculosis medication. The occurrence of pericarditis in all its forms and the possibility of developing constrictive pericarditis, the association of concomitant myocarditis with severe systolic dysfunction and complication with acute heart failure phenomena, and the long-term development of aortic aneurysms with risk of complications, as well as drug-induced toxicity, pose complex additional problems in the management of patients with TB. In the era of multidisciplinarity and polymedication, evidence-based medicine provides various tools that facilitate an integrative management that allows early diagnosis and treatment of cardiac pathologies associated with TB.
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Chen Y, Sheng B, Li J, Lv F. Tuberculous Thoracic Aortic Pseudoaneurysm Associated With Spinal Tuberculosis: A Case Report and Literature Review. Front Med (Lausanne) 2022; 9:882697. [PMID: 35721076 PMCID: PMC9198831 DOI: 10.3389/fmed.2022.882697] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Accepted: 05/09/2022] [Indexed: 11/13/2022] Open
Abstract
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.
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Affiliation(s)
- Yurou Chen
- Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Bo Sheng
- Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Jia Li
- Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Furong Lv
- Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
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Tran HV, Ho DK, Le VH, Van Duong H. Ruptured tuberculous aneurysms of the abdominal aorta: Two case series. Int J Surg Case Rep 2022; 92:106860. [PMID: 35231736 PMCID: PMC8886133 DOI: 10.1016/j.ijscr.2022.106860] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Revised: 02/17/2022] [Accepted: 02/22/2022] [Indexed: 11/17/2022] Open
Abstract
Background Ruptured aneurysms secondary to the tuberculous infection of the aorta are a rare and life-threatening disease. We report a single-center experience of two patients with ruptured infrarenal tuberculous aneurysms. Case presentation We report 2 patients with ruptures of the tuberculous aneurysm. All patients had acute abdominal pain and were diagnosed by echography then CT scan preoperatively. The first patient (male, 50 years old) had a ruptured saccular aneurysm. The second patient (male, 43 years old) had a retroperitoneal contained rupture. All were treated by open prosthetic repair, by vascular surgeons. The two patients were well after operations. The diagnosis was confirmed by pathology examination. Antituberculous treatment was introduced after the operation. Conclusions Ruptured tuberculous aneurysms are rare but life-threatening. The diagnosis requires a high degree of suspicion. The treatment includes early diagnosis and emergent surgical intervention, extensive excision of infected field, aortic reconstruction, and prolonged antituberculous drug therapy. The tuberculous aortic aneurysm is a fatal condition if not early diagnosed and properly treated. The diagnosis requires a high degree of suspicion. Surgery is necessary for stenotic or aneurysmal lesions. The treatment should be a combination of surgery and antituberculous medication.
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He H, Wang J, Li Q, Li X, Li M, Wang T, Li J, Wang L, Shu C. Endovascular repair combined with adjunctive procedures in the treatment of tuberculous infected native aortic aneurysms. J Vasc Surg 2022; 76:538-545.e2. [PMID: 35182661 DOI: 10.1016/j.jvs.2022.01.136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Accepted: 01/28/2022] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The present study aimed to analyze the experience of a single center and assess the efficacy and durability of endovascular aortic repair (EVAR) in patients with tuberculous infected native aortic aneurysms (INAAs). METHODS All patients who underwent EVAR for INAAs between September 2014 and August 2021 were retrospectively reviewed. The primary endpoints were 30-day and overall mortality rates; the secondary outcomes included major complications, endoleak, recurrence, re-intervention rate, and thrombosis of the pseudoaneurysmal sac. RESULTS A total of 18 patients (average age 61.3 years; 10 female [55.6%]) were identified. Fifteen patients (83.3%) had adjunctive procedures in addition to EVAR. Both the in-hospital and 30-day mortality rates were 0%. The overall cumulative survival rates estimated by Kaplan-Meier were 100% at 1 and 6 months, and 92.3% at 12, 24, and 80.8% at 36 and 48 months. Type Ib and II endoleak each occurred in 1 (5.6%) patient and resolved without treatment after 1 month. No graft infections, strokes, paraplegia, ischemic abdominal complications, or other major complications occurred. The overall rates of cumulative freedom from recurrence of aneurysm and re-intervention were 83.9% and 81.8%, respectively, during the median follow-up period of 28.5 (1-72) months. The median time of administering anti-tuberculosis drugs was 10.5 (2-44) months. CONCLUSIONS EVAR combined with oral anti-tuberculosis medication is effective and may be an appealing treatment option for high risk INAAs patients. Adjunctive procedures, including targeted drug delivery to the site of infection, could be a solution to further controlling the infection but still needs further evaluation.
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Affiliation(s)
- Hao He
- Department of Vascular Surgery, The Second Xiangya Hospital, Central South University, Changsha, China; The Institute of Vascular Diseases, Central South University, Changsha, China
| | - Junwei Wang
- Department of Vascular Surgery, The Second Xiangya Hospital, Central South University, Changsha, China; The Institute of Vascular Diseases, Central South University, Changsha, China
| | - Quanming Li
- Department of Vascular Surgery, The Second Xiangya Hospital, Central South University, Changsha, China; The Institute of Vascular Diseases, Central South University, Changsha, China
| | - Xin Li
- Department of Vascular Surgery, The Second Xiangya Hospital, Central South University, Changsha, China; The Institute of Vascular Diseases, Central South University, Changsha, China
| | - Ming Li
- Department of Vascular Surgery, The Second Xiangya Hospital, Central South University, Changsha, China; The Institute of Vascular Diseases, Central South University, Changsha, China
| | - Tun Wang
- Department of Vascular Surgery, The Second Xiangya Hospital, Central South University, Changsha, China; The Institute of Vascular Diseases, Central South University, Changsha, China
| | - Jiehua Li
- Department of Vascular Surgery, The Second Xiangya Hospital, Central South University, Changsha, China; The Institute of Vascular Diseases, Central South University, Changsha, China
| | - Lunchang Wang
- Department of Vascular Surgery, The Second Xiangya Hospital, Central South University, Changsha, China; The Institute of Vascular Diseases, Central South University, Changsha, China
| | - Chang Shu
- Department of Vascular Surgery, The Second Xiangya Hospital, Central South University, Changsha, China; The Institute of Vascular Diseases, Central South University, Changsha, China; Center of Vascular Surgery, State Key Laboratory of Cardiovascular Diseases, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China.
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Fu PT, Wu GM, Shi Y, Zhu ZJ, Luo MY, Guo YY. WITHDRAWN: Endovascular Repair with Stent-Graft of Symptomatic Tuberculous Aortic Pseudoaneurysm. Ann Vasc Surg 2021:S0890-5096(21)00523-9. [PMID: 34437958 DOI: 10.1016/j.avsg.2021.05.045] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Revised: 03/04/2021] [Accepted: 05/23/2021] [Indexed: 11/30/2022]
Abstract
This article has been withdrawn at the request of the author(s) and/or editor. The Publisher apologizes for any inconvenience this may cause. The full Elsevier Policy on Article Withdrawal can be found at https://www.elsevier.com/about/our-business/policies/article-withdrawal.
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Affiliation(s)
- Pin-Ting Fu
- Vascular Surgery department, Affiliated Cardiovascular Hospital of Kunming Medical University/Fuwai Yunnan Cardiovascular Hospital, Kunming, China
| | - Guang-Min Wu
- Vascular Surgery department, Affiliated Cardiovascular Hospital of Kunming Medical University/Fuwai Yunnan Cardiovascular Hospital, Kunming, China
| | - Yin Shi
- Vascular Surgery department, Affiliated Cardiovascular Hospital of Kunming Medical University/Fuwai Yunnan Cardiovascular Hospital, Kunming, China
| | - Zi-Jian Zhu
- Vascular Surgery department, Affiliated Cardiovascular Hospital of Kunming Medical University/Fuwai Yunnan Cardiovascular Hospital, Kunming, China
| | - Ming-Yao Luo
- Vascular Surgery department, Affiliated Cardiovascular Hospital of Kunming Medical University/Fuwai Yunnan Cardiovascular Hospital, Kunming, China
| | - Yuan-Yuan Guo
- Vascular Surgery department, Affiliated Cardiovascular Hospital of Kunming Medical University/Fuwai Yunnan Cardiovascular Hospital, Kunming, China.
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TEVAR for thoracic mycotic aneurysm: Case report. Int J Surg Case Rep 2021; 81:105753. [PMID: 33770636 PMCID: PMC7994787 DOI: 10.1016/j.ijscr.2021.105753] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Revised: 03/07/2021] [Accepted: 03/07/2021] [Indexed: 12/02/2022] Open
Abstract
Rare cause of mycotic aortic pseudoaneurysm. Sacciform aneurysm with high rate of mortality secondary to aneurysm rupture regadless its size. Open Surgery was the reference treatement, althoough accopagned with great risks. TEVAR with anti tuberculosis drugs have revolutionized the management and the outcomes of thoracic mycotic aneurysms.
Introduction Mycobacterium tuberculosis is a cause of mycotic aortic pseudoaneurysms, wich are a rare case with high mortality rates. Three types of dissemination hematogenous by contiguity and direct to the aortic wall are possibles. Presentation of case We report a rare case of tuberculous thoracic aortic pseudo aneurysm, successfully treated endovascularly associated to antituberculosis drugs. Discussion Classically TB pseudoaneurisms have been treated with open surgical therapy.however, they are associated to high morbidity and mortaity with increased lenghts of hospital stay. Due to advancements of endovascular technology, it be cames a good and successful alternative as a treatment, with a background of medical treatment. Conclusion Thoracic endovascular aneurysm repair (TEVAR) associated to anti-tuberculosis medication have revolutionized the management and improved the prognosis of this pathology.
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Abstract
RATIONALE We present a rare case of multiple tuberculous mycotic aneurysm. Multiple aneurysms caused by tuberculosis (TB) are difficult to treat. Here, we discuss a treatment modality using a microcore stent graft. PATIENT CONCERNS A 73-year-old man with pain in the back and on the right side of the chest associated with dry cough, presented with an inability to walk since 1-month. DIAGNOSES A diagnosis of multiple aneurysms caused by TB was made, based on computed tomography (CT) scan and positive T-spot and Xpert tests. INTERVENTIONS We administered the empirical anti-TB regimen (pyrazinamide, isoniazid, rifampicin, and ethambutol) and performed endovascular repair using microcore stent graft. OUTCOMES The post-operative hemodynamic analysis indicated that the patient's aneurysms no longer had a risk of rupture, and blood flow in the major branches of the aorta had been maintained. However, the patient could not survive due to a pulmonary infection acquired during recuperation at a local hospital. LESSONS For multiple tuberculous mycotic aneurysms, anti-TB therapy is inadequate and the microcore stent graft is a feasible option that can improve the hemodynamics in the aneurysms.
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Affiliation(s)
- Shenyu Zhao
- Department of Vascular Surgery, First Affiliated Hospital of Chongqing Medical University
| | - Zhe Wang
- Department of Vascular Surgery, First Affiliated Hospital of Chongqing Medical University
| | - Yong Li
- Department of Respiratory Medicine, People's Hospital of Tongliang District
| | - Hong Wang
- Academy of Life Sciences of Chongqing Medical University
| | - Yu Zhao
- Department of Vascular Surgery, First Affiliated Hospital of Chongqing Medical University
- Yuanjiagang, Yuzhong District, Chongqing, China
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9
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Li W, Sun X, Li H, Meng Z, Yang Y, Yao S. Endovascular treatment of a ruptured thoracic aortic pseudoaneurysm secondary to Pott disease during a spine surgery: A case report and a literature review. Medicine (Baltimore) 2019; 98:e15306. [PMID: 31008983 PMCID: PMC6494369 DOI: 10.1097/md.0000000000015306] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
RATIONALE The coexistence of a tuberculous aortic pseudoaneurysm and Pott disease in patients with a history of tuberculosis (TB) is relatively rare, and the treatment strategies remain still controversial. PATIENT CONCERNS A 57-year-old female patient with a history of primary pulmonary TB presented with symptoms of breathlessness, chest pain, weight loss, and fever. Magnetic resonance imaging (MRI) and computed tomography (CT) showed a thoracic aortic pseudoaneurysm secondary to Pott disease at T11/12 level. DIAGNOSES Tuberculous pseudoaneurysm at the descending thoracic aorta associated with tuberculous vertebral osteomyelitis. INTERVENTIONS We originally planned a combined surgery consisting of posterior spine stabilization, anterior excision of the infected field, and aortic reconstruction. When we surgically stabilized the posterior spine, unexpectedly, the pseudoaneurysm ruptured. Immediately, we terminated the surgery and appropriately placed an endovascular stent graft, which successfully rescued the patient. OUTCOMES When the patient's conditions were stable, we anteriorly debrided all infected tissues and then performed a spinal fusion by grafting autologous iliac bone. After the debridement and spinal fusion, we arranged a 1-year anti-tuberculous chemotherapy for this patient and performed a 24-month follow-up. This patient had no signs of recurrent infection during the follow-up. LESSONS For the patients with tuberculous aortic aneurysm(s) complicated with vertebral osteomyelitis, the endovascular repair of an aneurysm(s) should be considered a conventional therapy before the spine surgery, lowering the risk of aortic aneurysm rupture. Meanwhile, minimally invasive endovascular stent graft combined with anti-tuberculosis drugs may be considered one of the therapeutic regimens for the patients whose conditions are not suitable for open surgery, such as age, weakness, or severe organ failure.
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Affiliation(s)
- Weichao Li
- Faculty of Medical Science, Kunming University of Science and Technology
- Department of Orthopedic Surgery
| | - Xianrun Sun
- Faculty of Medical Science, Kunming University of Science and Technology
- Department of Orthopedic Surgery
| | - Hongrong Li
- Department of Cardiovascular Surgery, The First People's Hospital of Yunnan Province, Affiliated Hospital of Kunming University of Science and Technology, Kunming, China
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Ikeda S, Shih M, Likourezos A, Flom P, Rhee RY, Youdelman BA. The treatment of tuberculous aortic pseudoaneurysm. J Card Surg 2018; 33:840-852. [DOI: 10.1111/jocs.13952] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Shinichiro Ikeda
- Department of Surgery, Division of Cardiothoracic Surgery; Maimonides Medical Center; Brooklyn New York
| | - Michael Shih
- Department of Surgery, Division of Vascular Surgery; Maimonides Medical Center; Brooklyn New York
| | - Antonios Likourezos
- Department of Emergency Medicine, Research manager/Statistical Analysis Consultant; Maimonides Medical Center; Brooklyn New York
| | - Peter Flom
- Peter Flom Consulting; New York New York
| | - Robert Y. Rhee
- Department of Surgery, Division of Vascular Surgery; Maimonides Medical Center; Brooklyn New York
| | - Benjamin A. Youdelman
- Department of Surgery, Division of Cardiothoracic Surgery; Maimonides Medical Center; Brooklyn New York
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Sandwich EVAR occludes Celiac and Superior Mesenteric Artery for Infected Suprarenal Abdominal Aortic Aneurysm Treatment. Case Rep Vasc Med 2018; 2018:4037683. [PMID: 29862116 PMCID: PMC5971266 DOI: 10.1155/2018/4037683] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2018] [Accepted: 04/05/2018] [Indexed: 11/17/2022] Open
Abstract
Introduction. Infected aortoiliac aneurysms are rare, representing only 1% to 2% of all aortic aneurysms; we present a case of infected suprarenal aortic aneurysm with a nearly occluded celiac artery and superior mesenteric artery treated using an endovascular technique to preserve collateral in the retroperitoneal space from the inferior mesenteric artery for supplying visceral organs.
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Xue J, Yao Y, Liu L. Treatment of tuberculous aortic pseudoaneurysm associated with vertebral tuberculosis: A case series and a literature review. Medicine (Baltimore) 2018; 97:e0382. [PMID: 29642195 PMCID: PMC5908578 DOI: 10.1097/md.0000000000010382] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
RATIONALE Tuberculous aortic pseudoaneurysm associated with vertebral tuberculosis is a rare disease but with very high mortality. We review the literature and find 19 reports with 22 patients. Here we report three cases with vertebral tuberculosis, who also have tuberculous pseudoaneurysm of the aorta. These patients were treated by different methods. We try to analyze the epidemiology, pathogenesis, presentation, and management of this disease to find the best treatment. PATIENT CONCERNS The patients presented with different symptoms such as pain (chest, abdominal or back), fever, blood volume reduction or hemorrhagic shock symptoms. Large mass also could be observed by imaging. In addition to clinical manifestations, enhanced computed tomography or magnetic resonance imaging could also help the diagnosis of this disease. DIAGNOSES Tuberculous aortic pseudoaneurysm associated with vertebral tuberculosis. INTERVENTIONS Three patients were treated with anti-tuberculosis(TB) drugs or combined with different sequences surgical treatment: Case 1 refused to receive pseudoaneurysm surgery and only had anti-TB drug treatment; Case 2 received thoracic spinal surgery first; Case 3 received endovascular stent grafting. OUTCOMES Two patients (case 1 and case 2) who refused to undergo aneurysm surgery died. The last patient (case 3) underwent endovascular repair and antibiotic therapy for tuberculosis, and the postoperative course was uneventful; the patient recovered and survived. LESSONS Once the diagnosis of tuberculous pseudoaneurysm is confirmed, surgical treatment should be provided immediately combined with anti-tuberculosis drugs. The aim of the treatment is to save lives, prevent relapse, and facilitate the return to normal life, regardless of the size of the pseudoaneurysm. The pseudoaneurysm should be treated first to prevent aneurysm rupture before the vertebral tuberculosis surgery.
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MESH Headings
- Adult
- Aneurysm, False/diagnosis
- Aneurysm, False/etiology
- Aneurysm, False/physiopathology
- Aneurysm, False/surgery
- Antitubercular Agents/therapeutic use
- Aortitis/diagnosis
- Aortitis/etiology
- Aortitis/therapy
- Combined Modality Therapy/methods
- Female
- Humans
- Magnetic Resonance Imaging/methods
- Male
- Middle Aged
- Spinal Fusion/methods
- Thoracic Vertebrae/microbiology
- Thoracic Vertebrae/pathology
- Tomography, X-Ray Computed/methods
- Treatment Outcome
- Tuberculosis, Cardiovascular/complications
- Tuberculosis, Cardiovascular/diagnosis
- Tuberculosis, Spinal/diagnosis
- Tuberculosis, Spinal/drug therapy
- Tuberculosis, Spinal/physiopathology
- Tuberculosis, Spinal/surgery
- Vascular Surgical Procedures/methods
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Affiliation(s)
- Jing Xue
- Department of Orthopaedics, West China Hospital, Sichuan University
| | - Yimin Yao
- Department of Orthopaedics, PLA 452th Hospital, Chengdu, China
| | - Limin Liu
- Department of Orthopaedics, West China Hospital, Sichuan University
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13
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Manika K, Efthymiou C, Damianidis G, Zioga E, Papadaki E, Lagoudi K, Kioumis I. Miliary tuberculosis in a patient with tuberculous mycotic aneurysm of the abdominal aorta: Case report and review of the literature. Respir Med Case Rep 2017; 21:30-35. [PMID: 28377878 PMCID: PMC5369367 DOI: 10.1016/j.rmcr.2017.03.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2017] [Revised: 03/13/2017] [Accepted: 03/19/2017] [Indexed: 11/08/2022] Open
Abstract
The combination of miliary tuberculosis and tuberculous mycotic aneurysm has been described in the literature. We present the case of an 84-year-old man who was diagnosed with a mycotic aneurysm of the abdominal aorta and an adjacent soft tissue mass, after a 3- month history of fever. The patient underwent endovascular restoration of the aneurysm and was treated with broad-spectrum antibiotics. One and a half months later the fever relapsed and the chest CT scan revealed findings consistent with miliary tuberculosis and opacities of both upper lobes not present before, while the abdominal CT scan revealed an increase in the size of the para-aortic mass. Tuberculosis was documented by positive culture for M. tuberculosis of bronchial washing and by the CT-guided para-aortic mass biopsy. The patient received anti-TB treatment for 9 months leading to a spectacular improvement of his clinical condition and imaging findings. A review of the literature since 2008 revealed 28 more cases of tuberculous mycotic aneurysm. The treatment and outcome of all cases are described. Mycotic aneurysm of tuberculous etiology remains a reality and has a relatively good prognosis. Although miliary tuberculosis affects mortality even elderly patients may benefit from "aggressive" management and treatment.
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Affiliation(s)
- Katerina Manika
- Respiratory Infections Unit, Pulmonary Department, Aristotle University of Thessaloniki, G. Papanikolaou Hospital, Greece
| | - Christoforos Efthymiou
- Respiratory Infections Unit, Pulmonary Department, Aristotle University of Thessaloniki, G. Papanikolaou Hospital, Greece
| | - Georgios Damianidis
- 1st Internal Medicine Department, Ippokrateion General Hospital, Thessaloniki, Greece
| | - Elisavet Zioga
- 1st Internal Medicine Department, Ippokrateion General Hospital, Thessaloniki, Greece
| | - Eleni Papadaki
- Respiratory Infections Unit, Pulmonary Department, Aristotle University of Thessaloniki, G. Papanikolaou Hospital, Greece
| | - Kalliopi Lagoudi
- Respiratory Infections Unit, Pulmonary Department, Aristotle University of Thessaloniki, G. Papanikolaou Hospital, Greece
| | - Ioannis Kioumis
- Respiratory Infections Unit, Pulmonary Department, Aristotle University of Thessaloniki, G. Papanikolaou Hospital, Greece
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14
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Abstract
Significant vascular complications are rare following systemic infections with Mycobacterium tuberculosis (TB). This report describes a 33-year-old man who presented with a short history of abdominal discomfort and febrile episodes with no prior history of infection with TB. Ultrasound, CT scan, and aortography confirmed the presence of a pseudoaneurysm originating from the posterior aspect of the supraceliac aorta at the level of the diaphragm. Via a full thoracoabdominal approach, periaortic inflammatory tissue and the aortic wall itself were debrided, and repair of the pseudoaneurysm was achieved with a synthetic patch. Mycobacterium tuberculosis was isolated from the aortic wall, and anti-TB medications were instituted. Postoperatively the patient did well and was discharged after 14 days. As illustrated by this case, tuberculous mycotic aneurysms of the aorta are optimally treated with a combination of medical and surgical therapy, and early diagnosis is essential to ensure survival.
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Affiliation(s)
- Thomas L Forbes
- Division of Vascular Surgery, London Health Sciences Centre, University of Western Ontario, London, Ontario, Canada.
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15
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Melissano G, Civilini E, Papa M, Del Guercio R, Chiesa R. Antalgic Flexion of the Lower Limb: An Unusual Presentation of Aortoiliac Infection with Psoas Muscle Abscess. Vasc Endovascular Surg 2016; 39:287-92. [PMID: 15920659 DOI: 10.1177/153857440503900311] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Psoas abscess with aortoiliac infection is rare. Patients are often symptomatic for a long time before the correct diagnosis is made. The authors report 4 cases in which the presenting symptom was an antalgic flexion of the left thigh. In 2 patients the cause was an aortic graft infection with enteric fistula; in the other 2, infection developed after transfemoral endovascular procedures. Open surgical treatment was performed in 3 cases and percutaneous drainage in 1. One surgical patient with a late diagnosis eventually died of sepsis; the other 3 are alive and well at mean follow-up of 14 months.
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Affiliation(s)
- Germano Melissano
- Chair of Vascular Surgery, Vita-Salute University, Scientific Institute H. San Raffaele, Milan, Italy.
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16
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Tijani Y, Ghannam A, Elfatemi B, Elkharroubi A, Hormat-Allah M, Elidrissi R, Elkhloufi S, Sefiani Y, Lekehal B, Elmesnaoui A, Ammar F, Bensaid Y. [The aneurysms of the aorta of tuberculous]. Ann Cardiol Angeiol (Paris) 2016; 65:107-110. [PMID: 26656506 DOI: 10.1016/j.ancard.2015.09.047] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2014] [Accepted: 09/03/2015] [Indexed: 06/05/2023]
Abstract
Tuberculosis is a public health problem in Morocco, which is difficult to eradicate despite the recognized efficiency of health policies. Aortic aneurysm is rare and lethal complication of spontaneous evolution. Pathophysiological characteristics and the difficulty of early diagnosis worsen the prognosis.
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Affiliation(s)
- Y Tijani
- Service de chirurgie vasculaire, université Mohammed V, CHU Ibn Sina, Souissi Rabat, Maroc.
| | - A Ghannam
- Service d'anesthésie réanimation, université Mohammed V, CHU Ibn Sina, Souissi Rabat, Maroc
| | - B Elfatemi
- Service de chirurgie vasculaire, université Mohammed V, CHU Ibn Sina, Souissi Rabat, Maroc
| | - A Elkharroubi
- Service de chirurgie vasculaire, université Mohammed V, CHU Ibn Sina, Souissi Rabat, Maroc
| | - M Hormat-Allah
- Service de chirurgie vasculaire, université Mohammed V, CHU Ibn Sina, Souissi Rabat, Maroc
| | - R Elidrissi
- Service de chirurgie vasculaire, université Mohammed V, CHU Ibn Sina, Souissi Rabat, Maroc
| | - S Elkhloufi
- Service de chirurgie vasculaire, université Mohammed V, CHU Ibn Sina, Souissi Rabat, Maroc
| | - Y Sefiani
- Service de chirurgie vasculaire, université Mohammed V, CHU Ibn Sina, Souissi Rabat, Maroc
| | - B Lekehal
- Service de chirurgie vasculaire, université Mohammed V, CHU Ibn Sina, Souissi Rabat, Maroc
| | - A Elmesnaoui
- Service de chirurgie vasculaire, université Mohammed V, CHU Ibn Sina, Souissi Rabat, Maroc
| | - F Ammar
- Service de chirurgie vasculaire, université Mohammed V, CHU Ibn Sina, Souissi Rabat, Maroc
| | - Y Bensaid
- Service de chirurgie vasculaire, université Mohammed V, CHU Ibn Sina, Souissi Rabat, Maroc
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17
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Hung YM, Chang YT, Wang JS, Wang PYP, Wann SR. A rare but potentially lethal case of tuberculous aortic aneurysm presenting with repeated attacks of abdominal pain. Intern Med 2015; 54:1145-8. [PMID: 25948366 DOI: 10.2169/internalmedicine.54.3620] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Tuberculous aortic aneurysm is an extremely rare disease with a high mortality rate. The clinical features of this condition are highly variable, ranging from asymptomatic with or without constitutional symptoms, abdominal pain to frank rupture, bleeding and shock. We herein report the case of a 56-year-old man with a large tuberculous mycotic aneurysm in the abdominal aorta with an initial presentation of repeated attacks of abdominal pain lasting for several months. Due to the vague nature of the initial symptoms, tuberculous aortic aneurysms may take several months to diagnose. This case highlights the importance of having a high index of suspicion and providing timely surgery for this rare but potentially lethal disease.
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MESH Headings
- Abdominal Pain/etiology
- Abdominal Pain/microbiology
- Abdominal Pain/therapy
- Aneurysm, Infected/diagnosis
- Aneurysm, Infected/microbiology
- Aneurysm, Infected/therapy
- Antibiotics, Antitubercular/administration & dosage
- Aorta, Abdominal/microbiology
- Aorta, Abdominal/pathology
- Aortic Aneurysm, Abdominal/diagnosis
- Aortic Aneurysm, Abdominal/microbiology
- Aortic Aneurysm, Abdominal/therapy
- Follow-Up Studies
- Humans
- Male
- Middle Aged
- Tomography, X-Ray Computed
- Treatment Outcome
- Tuberculosis, Cardiovascular/complications
- Tuberculosis, Cardiovascular/diagnosis
- Tuberculosis, Cardiovascular/microbiology
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Affiliation(s)
- Yao-Min Hung
- Department of Emergency Medicine, Kaohsiung Veterans General Hospital, 2) Yuhing Junior College of Health Care and Management, Taiwan
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18
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Kumar P, Zhang J, Miller S, Wilton G. Yersinia enterocolitica: a rare cause of infected aortic aneurysm successfully treated with antibiotics and endovascular repair. JMM Case Rep 2014. [DOI: 10.1099/jmmcr.0.002626] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Affiliation(s)
| | - John Zhang
- Timaru Hospital, South Canterbury, 7910, New Zealand
| | - Sarah Miller
- Timaru Hospital, South Canterbury, 7910, New Zealand
| | - Gavin Wilton
- Timaru Hospital, South Canterbury, 7910, New Zealand
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19
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Kuhan G, Abisi S, Chandrasekar SN, MacSweeney ST. Endovascular Aneurysm Repair of Tuberculous Mycotic Abdominal Aortic Aneurysm on a Patient With Renal Transplant. Vasc Endovascular Surg 2012; 47:135-7. [DOI: 10.1177/1538574412470738] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Ganesh Kuhan
- Department of Vascular and Endovascular Surgery, Queens Medical Centre, Nottingham, United Kingdom
| | - S. Abisi
- Department of Vascular and Endovascular Surgery, Queens Medical Centre, Nottingham, United Kingdom
| | - S. N. Chandrasekar
- Department of Vascular and Endovascular Surgery, Queens Medical Centre, Nottingham, United Kingdom
| | - S. T. MacSweeney
- Department of Vascular and Endovascular Surgery, Queens Medical Centre, Nottingham, United Kingdom
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20
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Lee SH, Chung CH, Jung SH, Lee JW, Shin JH, Ko KY, Yoon HK, Choo SJ. Midterm outcomes of open surgical repair compared with thoracic endovascular repair for isolated descending thoracic aortic disease. Korean J Radiol 2012; 13:476-82. [PMID: 22778570 PMCID: PMC3384830 DOI: 10.3348/kjr.2012.13.4.476] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2011] [Accepted: 12/09/2011] [Indexed: 11/15/2022] Open
Abstract
Objective This study aimed to assess the surgical morbidity and mortality of thoracic endovascular repair (TEVAR) as compared with open surgical repair (OSR) for isolated descending thoracic aortic disease. Materials and Methods From January 1, 2006 through May 31, 2010, a total of 68 patients with isolated descending thoracic aortic disease were retrospectively reviewed for the presence of perioperative complication, 30-day mortality, and clinical success. The patients were divided into two groups (group 1, OSR, n = 40 vs. group 2, TEVAR, n = 28) and these groups were compared for major variables and late outcomes. Results The mean age was 58 years (group I = 54 vs. group II = 63 years, p = 0.011). Significant perioperative complications occurred in 12 patients: 8 (20%) in group I and 4 (13%) in group II (p = 0.3). There were five 30 day mortalities of which 4 occurred in group I and 1 in group II (p = 0.23). Clinical success (effective aortic remodeling and complete false lumen obliteration or thrombosis) was achieved in 20 patients (71%). Mean Kaplan-Meier survival rate at 1 year was similar for both groups (group 1 = 87% vs. group 2 = 80%, p = 0.65). Conclusion Thoracic endovascular repair for isolated thoracic aortic disease shows comparable results to OSR. However, the potential for endoleak or rupture remains a challenge that needs to be addressed in the future. Therefore, close follow-up study is needed for the evaluation of satisfactory long-term outcomes.
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Affiliation(s)
- Seung Hyun Lee
- Department of Thoracic and Cardiovascular Surgery, Dongsan Medical Center, Keimyung University College of Medicine, Daegu 700-712, Korea
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21
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Nakayama Y, Yamaki F, Matsumura Y. Endovascular aneurysm repair of saccular descending thoracic pseudoaneurysm possibly associated with tuberculosis. Gen Thorac Cardiovasc Surg 2012; 60:501-3. [PMID: 22700454 DOI: 10.1007/s11748-012-0038-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2011] [Accepted: 09/05/2011] [Indexed: 11/26/2022]
Abstract
In 2010, an 84-year-old man underwent thoracic endovascular aneurysm repair (TEVAR) for the saccular descending thoracic pseudoaneurysm (DTAA), which was adherent to the pulmonary lobe and thoracic vertebrae. Past medical history comprised twice anti-tuberculous medications for pulmonary tuberculosis and tuberculous vertebral osteomyelitis. The dilated aorta was detected at the time of medication for tuberculous vertebral osteomyelitis 24 years ago. However, he was not indicated for the operation, and he was lost to follow-up until now. The association of tuberculosis bacilli was suspected through clinical course as an origin of DTAA, although the histopathological examination was not performed because of invasion. TEVAR was performed considering: (1) no preoperative ongoing inflammation, (2) no evidence of tuberculosis recurrence, and (3) risk factors, such as pulmonary impairments and high age. Several months have been passed since the operation, and the patient remains well without perioperative anti-tuberculous medications.
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MESH Headings
- Aged, 80 and over
- Aneurysm, False/diagnosis
- Aneurysm, False/drug therapy
- Aneurysm, False/microbiology
- Aneurysm, False/surgery
- Aneurysm, Infected/diagnosis
- Aneurysm, Infected/drug therapy
- Aneurysm, Infected/microbiology
- Aneurysm, Infected/surgery
- Antitubercular Agents/therapeutic use
- Aortic Aneurysm, Thoracic/diagnosis
- Aortic Aneurysm, Thoracic/drug therapy
- Aortic Aneurysm, Thoracic/microbiology
- Aortic Aneurysm, Thoracic/surgery
- Aortography/methods
- Blood Vessel Prosthesis Implantation
- Endovascular Procedures
- Humans
- Male
- Tomography, X-Ray Computed
- Treatment Outcome
- Tuberculosis, Cardiovascular/diagnosis
- Tuberculosis, Cardiovascular/drug therapy
- Tuberculosis, Cardiovascular/microbiology
- Tuberculosis, Cardiovascular/surgery
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Affiliation(s)
- Yuki Nakayama
- Department of Cardiovascular Surgery, Nagano Chuo Hospital, Nishitsuruga, Nagano, Nagano, Japan.
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22
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Endovascular Treatment of an Aortoiliac Tuberculous Pseudoaneurysm. Cardiovasc Intervent Radiol 2012; 36:540-4. [DOI: 10.1007/s00270-012-0398-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2012] [Accepted: 04/10/2012] [Indexed: 10/28/2022]
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23
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24
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Hsu RB, Chang CI, Chan CY, Wu IH. Infected aneurysms of the suprarenal abdominal aorta. J Vasc Surg 2011; 54:972-8. [DOI: 10.1016/j.jvs.2011.04.024] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2011] [Revised: 04/07/2011] [Accepted: 04/07/2011] [Indexed: 02/08/2023]
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25
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Avaro JP, Amabile P, Paule P, Peloni JM, Piquet P. An unusual combination of a tuberculous aneurysm of the thoracic aorta and a degenerative aneurysm of the infrarenal abdominal aorta. Ann Vasc Surg 2011; 25:700.e9-700.e12. [PMID: 21724110 DOI: 10.1016/j.avsg.2010.12.034] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2010] [Revised: 09/10/2010] [Accepted: 12/13/2010] [Indexed: 11/30/2022]
Abstract
Tuberculous aneurysms of the aorta are rare and give rise to various issues related to their diagnosis and treatment. In this article, we report on an exceptional case concerning a patient who presented with a false tuberculous aneurysm of the thoracic aorta and a degenerative aneurysm of the infrarenal abdominal aorta concomitantly. A discussion on how we approached the diagnosis and devised a therapeutic strategy that allowed us to treat this dual aortic disease effectively has also been provided. The discussion includes details of the order of treatment and the choice between an endovascular and a surgical approach.
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Affiliation(s)
- Jean-Philippe Avaro
- Department of Thoracic Surgery, Military Hospital Laveran, Marseille, France.
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26
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Pierret C, Tourtier JP, Grand B, Boddaert G, Laurian C, de Kerangal X. Multiple tuberculous aneurysms of the aorta. J Vasc Surg 2011; 53:1720-2. [DOI: 10.1016/j.jvs.2011.01.063] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2010] [Revised: 01/24/2011] [Accepted: 01/24/2011] [Indexed: 10/18/2022]
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27
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Han DK, Chung C, Walkup MH, Faries PL, Marin ML, Ellozy SH. Endovascular stent-graft repair of a tuberculous mycotic aortic aneurysm. Ann Vasc Surg 2011; 25:699.e13-6. [PMID: 21514110 DOI: 10.1016/j.avsg.2010.12.029] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2010] [Revised: 11/05/2010] [Accepted: 12/24/2010] [Indexed: 11/19/2022]
Abstract
Mycobacterium tuberculosis is a rare cause of mycotic aortic aneurysms, which have been classically treated with a combination of antimycobacterial medical therapy and open surgery. Endovascular therapy has been gaining popularity as an alternative to open surgery for mycotic aneurysms. We report a case of a tuberculous mycotic aneurysm of the descending thoracic aorta that was successfully treated with endovascular stent-graft placement with complete resolution of the pseudoaneurysm at 1 year. We also review other cases in the previously published data to identify factors that may affect the outcome of endovascular treatment of tuberculous mycotic aneurysms.
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MESH Headings
- Aneurysm, False/diagnostic imaging
- Aneurysm, False/microbiology
- Aneurysm, False/surgery
- Aneurysm, Infected/diagnostic imaging
- Aneurysm, Infected/microbiology
- Aneurysm, Infected/surgery
- Antitubercular Agents/therapeutic use
- Aortic Aneurysm, Thoracic/diagnostic imaging
- Aortic Aneurysm, Thoracic/microbiology
- Aortic Aneurysm, Thoracic/surgery
- Aortography/methods
- Blood Vessel Prosthesis
- Blood Vessel Prosthesis Implantation/instrumentation
- Endovascular Procedures/instrumentation
- Female
- Humans
- Middle Aged
- Mycobacterium tuberculosis/isolation & purification
- Stents
- Tomography, X-Ray Computed
- Treatment Outcome
- Tuberculosis, Cardiovascular/microbiology
- Tuberculosis, Cardiovascular/surgery
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Affiliation(s)
- Daniel K Han
- Division of Vascular Surgery, Department of Surgery, Mount Sinai School of Medicine, New York, NY, USA.
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28
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29
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Mechchat A, Lekehal B, Mesnaoui A, Ammar F, Bensaid Y. Ruptured tuberculous false aneurysm of the abdominal aorta: a case report. Ann Vasc Dis 2011; 4:47-9. [PMID: 23555428 DOI: 10.3400/avd.cr.10.00002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2010] [Accepted: 12/20/2010] [Indexed: 11/13/2022] Open
Abstract
Tuberculous false aneurysm of the aorta is rare and has an unpredictable complication of aneurysm rupture. We report a case of a 32-year old woman who was referred to the Department of Vascular Surgery, Avicenne Hospital for severe abdominal pain. Chest x-ray revealed miliary tuberculosis. Contrast enhanced computed tomography (CT) scan showed a false aortic aneurysm involving the juxtarenal aorta. Antituberculous treatment was started because of high presumption of tuberculosis. Five days later, the patient presented with symptoms of aneurysm rupture. She underwent an emergency a surgical resection of the aneurysm with repair of the aortic wall defect by a Dacron Silver patch. The histopathologic examination of the aortic wall showed features of tuberculosis.
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Affiliation(s)
- Alae Mechchat
- Department of vascular surgery, Avicenne Hospital, Rabat, Morocco
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30
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Endovascular repair of a tuberculous mycotic thoracic aortic aneurysm with a custom-made device. J Vasc Surg 2010; 51:1272-5. [DOI: 10.1016/j.jvs.2009.12.047] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2009] [Revised: 12/14/2009] [Accepted: 12/15/2009] [Indexed: 11/19/2022]
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31
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Kan CD, Lee HL, Luo CY, Yang YJ. The Efficacy of Aortic Stent Grafts in the Management of Mycotic Abdominal Aortic Aneurysm—Institute Case Management with Systemic Literature Comparison. Ann Vasc Surg 2010; 24:433-40. [DOI: 10.1016/j.avsg.2009.08.004] [Citation(s) in RCA: 60] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2009] [Revised: 07/06/2009] [Accepted: 08/23/2009] [Indexed: 02/07/2023]
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32
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Shu C, He H, Li QM, Li M, Jiang XH, Li X. Endovascular percutaneous treatment of tuberculous pseudo-aneurysm involving the coeliac artery: a case report. Eur J Vasc Endovasc Surg 2010; 40:230-3. [PMID: 20399125 DOI: 10.1016/j.ejvs.2010.03.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2009] [Accepted: 03/02/2010] [Indexed: 10/19/2022]
Abstract
Pseudo-aneurysms involving the coeliac artery caused by tuberculosis infection are extremely rare and are highly susceptible to rupture.(1) It's difficult to make the correctly diagnosis preoperative and select reconstructive procedures. We report a case of tuberculous pseudo-aneurysm in the abdominal aorta involving the coeliac artery. The active phase of the tuberculous makes it impossible to perform open surgery, so endovascular percutaneous treatment was performed, inflow to the pseudo-aneurysm was excluded by placing a custom-made stent graft at the coeliac artery orifice. The patient recovered very well and was prescribed anti-tuberculosis treatment for up to 6 months. Endovascular repair for tuberculous pseudo-aneurysm may be a life-saving option, covering the coeliac artery with stent graft is considered safe and suitable.
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Affiliation(s)
- C Shu
- Department of Vascular Surgery, The Second Xiangya Hospital of Central South University, Middle Ren-Min Road No 139, Changsha, Hunan 410011, China.
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33
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Lefranc M, Peltier J, Bidaud M, Reix T. Anévrisme tuberculeux de l’aorte abdominale : cas clinique et revue de la littérature. Rev Med Interne 2009; 30:625-7. [DOI: 10.1016/j.revmed.2008.08.012] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2007] [Revised: 05/29/2008] [Accepted: 08/08/2008] [Indexed: 11/16/2022]
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34
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Mechchat A, Idrissi R, El Mahi O, Lekehal B, Sefiani Y, Mesnaoui A, Ammar F, Bensaid Y. Multiples anévrismes aortiques d’origine tuberculeuse chez un enfant. À propos d’un cas. ACTA ACUST UNITED AC 2008; 33:218-20. [DOI: 10.1016/j.jmv.2008.09.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2008] [Accepted: 09/10/2008] [Indexed: 11/24/2022]
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35
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Endovascular Stent Graft Placement in the Treatment of Ruptured Tuberculous Pseudoaneurysm of the Descending Thoracic Aorta: Case Report and Review of the Literature. Cardiovasc Intervent Radiol 2008; 32:572-6. [DOI: 10.1007/s00270-008-9456-8] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2008] [Revised: 08/28/2008] [Accepted: 09/03/2008] [Indexed: 10/21/2022]
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36
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Stent-Graft Treatment of Mycotic Aneurysms: A Review of the Current Literature. J Vasc Interv Radiol 2008; 19:S51-6. [DOI: 10.1016/j.jvir.2008.02.012] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2007] [Revised: 02/17/2008] [Accepted: 02/17/2008] [Indexed: 11/22/2022] Open
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37
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Hussein H, Azizi ZA. Tuberculous Aortic Pseudoaneurysm Treated with In Situ Silver-impregnated Vascular Inlay Graft. Asian J Surg 2008; 31:87-9. [DOI: 10.1016/s1015-9584(08)60064-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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38
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Vaquero-Lorenzo F, Álvarez-Salgado A, Vicente-Santiago M, Ramos-Gallo M, Vallina-Vázquez M, de la Torre P, Niembro-Martín P, Álvarez-Fernández L. Aneurisma de aorta abdominal causado por Mycobacterium tuberculosis. ANGIOLOGIA 2008. [DOI: 10.1016/s0003-3170(08)02009-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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39
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Lee EJ, Cho HS, Yoon HS, Lee JH, Lee TH, Yoo KH, Lee KY, Kim SJ. A Case of Tuberculosis Presented with Pseudoaneurysm of the Aorta and Acute Respiratory Distress Syndrome. Tuberc Respir Dis (Seoul) 2008. [DOI: 10.4046/trd.2008.64.4.298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Affiliation(s)
- Eung-Jun Lee
- Department of Internal Medicine, Konkuk University Hospital, School of Medicine, Konkuk University, Seoul, Korea
| | - Han-Su Cho
- Department of Internal Medicine, Konkuk University Hospital, School of Medicine, Konkuk University, Seoul, Korea
| | - Hyun-Sung Yoon
- Department of Internal Medicine, Konkuk University Hospital, School of Medicine, Konkuk University, Seoul, Korea
| | - Jung-Hyun Lee
- Department of Internal Medicine, Konkuk University Hospital, School of Medicine, Konkuk University, Seoul, Korea
| | - Tae Hoon Lee
- Department of Internal Medicine, Konkuk University Hospital, School of Medicine, Konkuk University, Seoul, Korea
| | - Kwang Ha Yoo
- Department of Internal Medicine, Konkuk University Hospital, School of Medicine, Konkuk University, Seoul, Korea
| | - Kye Young Lee
- Department of Internal Medicine, Konkuk University Hospital, School of Medicine, Konkuk University, Seoul, Korea
| | - Sun Jong Kim
- Department of Internal Medicine, Konkuk University Hospital, School of Medicine, Konkuk University, Seoul, Korea
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40
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Kan CD, Lee HL, Yang YJ. Outcome after endovascular stent graft treatment for mycotic aortic aneurysm: A systematic review. J Vasc Surg 2007; 46:906-12. [PMID: 17905558 DOI: 10.1016/j.jvs.2007.07.025] [Citation(s) in RCA: 226] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2007] [Revised: 07/16/2007] [Accepted: 07/19/2007] [Indexed: 02/06/2023]
Abstract
BACKGROUND Surgical treatment for mycotic aortic aneurysms is not optimal. Even with a large excision, extensive debridement, in situ or extra-anatomical reconstruction, and with or without lifelong antibiotic treatment, mycotic aneurysms still carry very high mortality and morbidity. The use of endovascular aneurysm repair (EVAR) for mycotic aortic aneurysms simplifies the procedure and provides a good alternative for this critical condition. However, the question remains: if EVAR is placed in an infected bed, what is the outcome of the infection? Does it heal, become aggravated, or even cause a disastrous aortic rupture? In this study, we tried to clarify the risk factors for such an adverse response. METHODS A literature review was undertaken by using MEDLINE. All relevant reports on endoluminal management of mycotic aortic aneurysms were included. Logistic regressions were applied to identify predictors of persistent infection. RESULTS A total of 48 cases from 22 reports were included. The life-table analysis showed that the 30-day survival rate was 89.6% +/- 4.4%, and the 2-year survival rate was 82.2% +/- 5.8%. By univariate analysis, age 65 years or older, rupture of the aneurysm (including those with aortoenteric fistula and aortobronchial fistula), and fever at the time of operation were identified as significant predictors of persistent infection, and preoperative use of antibiotics for longer than 1 week and an adjunct procedure combined with EVAR were identified as significant protective factors for persistent infection. However, by multivariate logistic regression analysis, the only significant independent predictors identified were rupture of aneurysm and fever. CONCLUSIONS EVAR seems a possible alternative method for treating mycotic aortic aneurysms. Identification of the risk factors for persistent infection may help to decrease surgical morbidity and mortality. EVAR could be used as a temporary measure; however, a definite surgical treatment should be considered for patients present with aneurysm rupture or fever.
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Affiliation(s)
- Chung-Dann Kan
- Department of Surgery, Division of Cardiovascular Surgery, National Cheng Kung University Hospital, Tainan, Taiwan
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41
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Labrousse L, Montaudon M, Le Guyader A, Choukroun E, Laurent F, Deville C. Endovascular treatment of a tuberculous infected aneurysm of the descending thoracic aorta: A word of caution. J Vasc Surg 2007; 46:786-8. [PMID: 17903655 DOI: 10.1016/j.jvs.2007.05.038] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2006] [Accepted: 05/15/2006] [Indexed: 10/22/2022]
Abstract
An infected aneurysm of the thoracic aorta due to mycobacterium tuberculosis is an unusual entity for which the classical treatment is antituberculosis chemotherapy and open-chest surgery. Recent improvements in endovascular treatments have led to their proposed use for infected aneurysms in patients for whom open surgery poses too high a risk. We report on a 68-year-old man with a tuberculous aortic aneurysm who had been treated with an endoprosthesis and antituberculosis chemotherapy. His clinical and radiological follow-up was uneventful and led to the discontinuation of pharmacological treatment after 16 months. However, a recurrence of the infection led to a fatal aortic rupture 4 months after discontinuation of therapy.
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MESH Headings
- Aged
- Aneurysm, Infected/diagnostic imaging
- Aneurysm, Infected/drug therapy
- Aneurysm, Infected/microbiology
- Aneurysm, Infected/therapy
- Aorta, Thoracic/diagnostic imaging
- Aortic Aneurysm, Thoracic
- Aortic Rupture/etiology
- Blood Vessel Prosthesis Implantation
- Fatal Outcome
- Humans
- Male
- Radiography
- Recurrence
- Tuberculosis, Cardiovascular/diagnosis
- Tuberculosis, Cardiovascular/diagnostic imaging
- Tuberculosis, Cardiovascular/drug therapy
- Tuberculosis, Cardiovascular/therapy
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Affiliation(s)
- Louis Labrousse
- Department of Cardio-Vascular Surgery, Bordeaux Heart University Hospital, Bordeaux-Pessac, France.
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42
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Steichen O. Aortic tuberculous pseudoaneurysm. Spine J 2007; 7:629. [PMID: 17662664 DOI: 10.1016/j.spinee.2007.05.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2007] [Accepted: 05/10/2007] [Indexed: 02/03/2023]
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43
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Narang AT, Rathlev NK. Non-aneurysmal infectious aortitis: a case report. J Emerg Med 2007; 32:359-63. [PMID: 17499687 DOI: 10.1016/j.jemermed.2006.07.030] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2004] [Revised: 01/04/2006] [Accepted: 07/05/2006] [Indexed: 11/21/2022]
Abstract
Infectious aortitis is a rare clinical entity that is most often associated with an abdominal aortic aneurysm. There have been very few documented cases of aortitis in the setting of a normal-sized caliber aorta. We present a 67-year-old patient who presented to our Emergency Department with a history of recent fevers, fatigue, and abdominal pain. Based on an abdominal computed tomography scan, the patient was initially thought to have ruptured an abdominal aortic aneurysm of infectious etiology with extension into the left psoas muscle. Explorative laparotomy, however, revealed an infected abdominal aorta secondary to a retroperitoneal abscess with no evidence of aneurysm or pseudoaneurysm. The pathophysiology of the disease suggests that infectious aortitis and mycotic aneurysm represent extremes along a spectrum of the same disease. Establishing a diagnosis of aortic infection before the formation of an aneurysm or rupture is very difficult, but essential in preventing the devastating complications.
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Affiliation(s)
- Aneesh T Narang
- Department of Emergency Medicine, Boston Medical Center, Boston, Massachusetts 02118, USA
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44
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Steichen O, Pellerin O, Frank M, Emmerich J, Sapoval M, Fiessinger JN, Bura-Rivière A. Traitement par voie endovasculaire d'un faux anévrisme tuberculeux de l'isthme aortique. Rev Med Interne 2007; 28:196-8. [PMID: 17175072 DOI: 10.1016/j.revmed.2006.11.017] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2006] [Accepted: 11/18/2006] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Aortic aneurysms are a well known but rare complication of tuberculosis. Their major complication is aneurysmal rupture, unforeseeable and lethal. EXEGESIS Chest pain and hemoptoic expectoration revealed a false aneurysm of the aortic isthmus in a 48-year-old man. Endovascular repair with a stent graft was urgently undertaken. Tuberculosis was diagnosed 6 weeks thereafter by the growth of gastric juice cultures and medically treated. Most tuberculous aortic aneurysms are false aneurysms, caused by an adjacent tuberculous focus eroding the aortic wall. They present with pain, bleeding or as para-aortic masses. CONCLUSION Tuberculous false aneurysms of the aorta necessitate an early intervention before they rupture. Surgical treatment remains the preferred option but endovascular repair with a stent graft is a therapeutic alternative, to be considered in high-risk surgical patients.
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Affiliation(s)
- O Steichen
- Laboratoire de Santé Publique et d'Informatique Médicale, Inserm, U729 Ingénierie des Connaissances en Santé, Institut de Recherche des Cordeliers, Paris, France.
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45
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Stephens CT, Pounds LL, Killewich LA. Rupture of a nonaneurysmal aorta secondary to Staphylococcus aortitis. Angiology 2006; 57:506-12. [PMID: 17022388 DOI: 10.1177/0003319706290739] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Infectious aortitis has become increasingly uncommon and, when diagnosed, typically occurs in an immunocompromised elderly male with a history of Staphylococcus or Salmonella infection and underlying atheromatous cardiovascular disease. The authors report a case of a 74-year-old man with aortitis complicated by rupture secondary to Staphylococcus aureus infection. The patient presented with worsening abdominal pain and fever after being discharged from the emergency room 2 weeks before with back pain and leukocytosis diagnosed as urinary tract infection and bronchitis. Computed tomography (CT) imaging of the retroperitoneum on the first visit appeared normal. Repeat CT scan on the subsequent visit revealed a contained rupture of a nonaneurysmal aorta at the level of the diaphragm. The patient was taken to the operating room emergently for repair. An infected periaortic hematoma and a 1 cm perforation in the posterior aorta were found. The aorta was excised and the area debrided. Revascularization was performed using a 22 mm extruded polytetrafluoroethylene (ePTFE) interposition graft placed in situ. This case demonstrates that a high index of suspicion is required in diagnosing infectious aortitis and that the diagnosis may be delayed in many cases. Additionally, it may not be uncommon for the infected aorta to rupture without prior aneurysm formation.
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Affiliation(s)
- Christopher T Stephens
- Department of Anesthesiology, Department of Surgery, University of Texas Medical Branch, Galveston, TX 77555-0735, USA
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46
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Falkensammer J, Behensky H, Gruber H, Prodinger WM, Fraedrich G. Successful treatment of a tuberculous vertebral osteomyelitis eroding the thoracoabdominal aorta: A case report. J Vasc Surg 2005; 42:1010-3. [PMID: 16275463 DOI: 10.1016/j.jvs.2005.07.011] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2005] [Accepted: 07/07/2005] [Indexed: 11/25/2022]
Abstract
Mycotic aortic aneurysms are rare complications of systemic tuberculosis that affect very few patients. We report a case of a false aneurysm of the visceral segment of the aorta that was associated with tuberculous vertebral osteomyelitis. Both conditions were successfully treated with antituberculous chemotherapy and a combined surgical procedure, ie, aneurysm resection and homograft implantation, followed by orthopedic stabilization of the spine.
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MESH Headings
- Aneurysm, False/diagnostic imaging
- Aneurysm, False/etiology
- Aneurysm, False/surgery
- Aneurysm, Infected/diagnostic imaging
- Aneurysm, Infected/etiology
- Aneurysm, Infected/surgery
- Antitubercular Agents/therapeutic use
- Aortic Aneurysm, Abdominal/diagnostic imaging
- Aortic Aneurysm, Abdominal/etiology
- Aortic Aneurysm, Abdominal/surgery
- Blood Vessel Prosthesis Implantation
- Follow-Up Studies
- Humans
- Lumbar Vertebrae
- Male
- Middle Aged
- Osteomyelitis/complications
- Osteomyelitis/diagnostic imaging
- Osteomyelitis/therapy
- Spinal Fusion
- Thoracic Vertebrae
- Tomography, X-Ray Computed
- Tuberculosis, Spinal/complications
- Tuberculosis, Spinal/diagnostic imaging
- Tuberculosis, Spinal/therapy
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47
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Shikata H, Nagayoshi Y, Takeuchi K, Ueda Y, Sakamoto S, Kanno M, Matsubara J. Successful Surgical Treatment of an Infrarenal Abdominal Pseudoaneurysm Caused by Tuberculosis: Report of a Case. Surg Today 2005; 35:991-5. [PMID: 16249860 DOI: 10.1007/s00595-005-3055-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2003] [Accepted: 01/18/2005] [Indexed: 10/25/2022]
Abstract
A 76-year-old man was admitted to our hospital for investigation of an apparent abdominal aortic aneurysm detected during treatment for epididymitis. A chest X-ray showed miliary shadows in the bilateral lung fields strongly suggestive of tuberculosis. The diameter of the aneurysm increased, and examinations showed impending rupture of a pseudoaneurysm. However, a definitive disease pathogenesis was not obtained before surgery. We performed a subemergency operation, which revealed an infrarenal abdominal pseudoaneurysm caused by tuberculosis. The pseudoaneurysm appeared to have resulted from direct extension of tuberculous lymphadenitis to the aortic wall, which ruptured. We review 24 other cases of tuberculous aortic aneurysms surgically treated in Japan before 2004.
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MESH Headings
- Aged
- Aneurysm, False/diagnosis
- Aneurysm, False/microbiology
- Aneurysm, False/surgery
- Aneurysm, Infected/diagnosis
- Aneurysm, Infected/surgery
- Aortic Aneurysm, Abdominal/diagnosis
- Aortic Aneurysm, Abdominal/microbiology
- Aortic Aneurysm, Abdominal/surgery
- Humans
- Male
- Tuberculosis, Lymph Node/complications
- Tuberculosis, Lymph Node/diagnosis
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Affiliation(s)
- Hiroo Shikata
- Department of Cardiovascular Surgery, Kanazawa Medical University, Ishikawa, Japan
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48
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Raffetto JD, Bernardo J, Menzoían JO. Aortobifemoral graft infection with mycobacterium tuberculosis: Treatment with abscess drainage, debridement, and long-term administration of antibiotic agents. J Vasc Surg 2004; 40:826-9. [PMID: 15472616 DOI: 10.1016/j.jvs.2004.07.041] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Aortic graft infection with Mycobacterium tuberculosis is rare. We report a patient with a Dacron aortobifemoral prosthetic graft infection secondary to tuberculosis. The infection was successfully treated with surgical drainage without removal of the graft, and long-term antimycobacterial medications. A review of the literature contains only 1 other report of tuberculosis graft infection and treatment. We discuss a rare form of aortic graft infection from M tuberculosis and its treatment.
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49
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Koeppel TA, Gahlen J, Diehl S, Prosst RL, Dueber C. Mycotic aneurysm of the abdominal aorta with retroperitoneal abscess: Successful endovascular repair. J Vasc Surg 2004; 40:164-6. [PMID: 15218478 DOI: 10.1016/j.jvs.2004.02.046] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Mycotic aortic aneurysms are rare. Improved diagnostic procedures, appropriate antibiotic treatment, and safe surgical techniques have reduced the high mortality associated with bacterial aortitis. However, definite evidence-based conclusions with regard to the surgical strategy cannot be drawn from the data available in the published literature. We report successful endovascular repair of a mycotic abdominal aortic aneurysm. Endovascular treatment may offer a benefit, especially in critically ill patients.
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Affiliation(s)
- Thomas A Koeppel
- Department of Surgery, University Hospital Mannheim, Faculty of Clinical Medicine of the University of Heidelberg, Germany.
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50
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Smith JJ, Taylor PR. Endovascular Treatment of Mycotic Aneurysms of the Thoracic and Abdominal Aorta: The Need for Level I Evidence. Eur J Vasc Endovasc Surg 2004; 27:569-70. [PMID: 15121104 DOI: 10.1016/j.ejvs.2004.01.022] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/13/2004] [Indexed: 02/08/2023]
Affiliation(s)
- J J Smith
- University of Texas Medical School, Houston, USA
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