Successful Endoluminal Repair of an Infected Thoracic Pseudoaneurysm Caused by Methicillin-Resistant Staphylococcus Aureus

Abstract

Purpose:

To report the successful endoluminal repair of an infected thoracic aneurysm secondary to methicillin-resistant Staphylococcus aureus (MRSA).

Case Report:

A 76-year-old man presented with an infected thoracic pseudoaneurysm 9 weeks after an elective infrarenal aneurysm repair. Blood cultures were positive for MRSA. Computed tomography (CT) showed an 11.5-cm false aneurysm of the descending thoracic aorta just proximal to the celiac axis. An Excluder stent-graft was used to successfully repair the lesion. Recovery was uneventful, and the patient was treated with linezolid for 6 weeks. Follow-up CT scans at 3 and 12 months confirmed exclusion of the aneurysm and progressive shrinkage of the aneurysm sac with no evidence of graft infection.

Conclusions:

Endoluminal repair is an alternative to open surgery for the treatment of infected aneurysms of the thoracic aorta.

Keywords

thoracic aorta mycotic aneurysm pseudoaneurysm methicillin infection endovascular repair stent-graft Excluder endoprosthesis

Get full access to this article

View all access options for this article.

References

Svensson

Crawford

. Aortic dissection and aortic aneurysm surgery: clinical observations, experimental investigations and statistical analyses, Part 1. Curr Probl Surg. 1992;29:817–911.

Virchow

. Ueber die Acute Entzunding der Arterian. Virchows Arch. 1847;1:272–275.

Osler

. The Gulstonian lectures on malignant endocarditis. Br Med J. 1885;1:467.

Hollier

Money

Creely

. Direct replacement of mycotic thoracoabdominal aneurysms. J Vasc Surg. 1993;18:477–485.

Krämer

Pamler

Seifarth

. Endovascular grafting of traumatic aortic aneurysms in contaminated fields. J Endovasc Ther. 2001;8:262–267.

Chan

Crawford

Coselli

. In situ prosthetic graft replacement for mycotic aneurysm of the aorta. Ann Thorac Surg. 1989;47:193–203.

Cina

Arena

Fiture

. Ruptured mycotic thoracic abdominal aortic aneurysms: a report of three cases and systematic review. J Vasc Surg. 2001;33:861–867.

Sueyoshi

Sakamoto

Kawahara

. Infected abdominal aortic aneurysms—early CT findings. Abdom Imaging. 1998;23:645–648.

Centers for Disease Control and Prevention. National Nosocomial Infection Surveillance System Report: Data Summary from October 1986-April 1996. Atlanta, GA: U.S. Department of Health and Human Services, 1996.

10.

Standing Medical Advisory Committee (Department of Health). The path of least resistance. Main report. London: Department of Health, 1998.

11.

Michel

Gutmann

. Methicillin-resistant Staphylococcus aureus and vancomycin-resistant enterococci: therapeutic realities and possibilities. Lancet. 1997;349:1901–1906.

12.

Volodos

Karpovich

Troyan

. Clinical experience of the use of self-fixing synthetic prostheses for remote endoprosthetics of the thoracic and the abdominal aorta and iliac arteries through the femoral artery and as intraoperative endoprosthesis for aorta reconstruction. Vasa Suppl. 1991;33:93–95.

13.

Mitchell

Dake

Semba

. Endovascular stent-graft repair of thoracic aortic aneurysms. J Thorac Cardiovasc Surg. 1996;111:1054–1062.

14.

Taylor

Gaines

McGuinness

. Thoracic aortic stent-grafts—early experience from two centers using commercially available devices. Eur J Vasc Endovasc Surg. 2001;22:70–76.

15.

Bergamini

Bandyk

Govostis

. Infection of vascular prostheses caused by bacterial biofilms. J Vasc Surg. 1988;7:21–30.