Treatment of a Mycotic Descending Thoracic Aortic Aneurysm Using Endovascular Stent-Graft Placement and Rifampin Infusion With Postoperative Aspiration of the Aneurysm Sac
Restricted accessCase reportFirst published online November, 2011
Treatment of a Mycotic Descending Thoracic Aortic Aneurysm Using Endovascular Stent-Graft Placement and Rifampin Infusion With Postoperative Aspiration of the Aneurysm Sac
Purpose: Mycotic aortic aneurysms are rare but are associated with high morbidity and mortality due to their propensity for rupture. Traditional therapy consists of open surgical repair with resection and aortic reconstruction or extra-anatomic bypass combined with long-term antibiotic therapy. Case report: An 85-year-old male with persistent bacteremia was found to have a descending mycotic aortic aneurysm. Surgical options were discussed and endovascular treatment was recommended with stent-graft placement followed by intra-aortic rifampin infusion. This approach led to resolution of the aneurysm and eradication of bacteremia at 4-month follow-up. Conclusion: By combining traditional surgical strategies with a contemporary endovascular approach, the perioperative mortality and long-term risk of infection associated with mycotic thoracic aneurysms can potentially be decreased.
ParkhurstGDeckerJ (1955). Bacterial aortitis and mycotic aneurysm of the aorta. Am J Pathol, 31(5):821–835.
2.
OslerW (1885). The Gulstonia lecturs on malignant endocarditis. Br Med J, 1(1262):467–470.
3.
SembaCSakaiTSlinomS (1998). Mycotic aneurysms of the thoracic aorta: repair with use of endovascular stent-grafts. J Vasc Interv Radiol, 9(1 pt 1):33–40.
4.
GrossCHarringerWMairRWimmer-GreineckerGKlimaUBrückeP (1994). Mycotic aneurysms of the thoracic aorta. Eur J Cardiothorac Surg, 8(3):135–138.
5.
LinMChangSWuRChouCKTzengWS (2008). A comparison of computed tomography, magnetic resonance imaging, and digital subtraction angiography findings in the diagnosis and infected aortic aneurysm. J Comput Assist Tomogr, 32(4):616–620.
6.
HsuRTsayTWangSChuS (2003). Management of aortic aneurysm infected with Samonella. Br J Surg, 90(9):1080–1084.
7.
NakataYShionayaSKamiyaK (1968). Pathogenesis of mycotic aneurysm. Angiology, 19(10):593–601.
8.
PatelSJohnstonK (1977). Classification and management of mycotic aneurysms. Surg Gynecol Obstet, 144(5):691–694.
9.
TaylorLDeitzDMcConnellDPorterJ (1988). Treatment of infected abdominal aneurysm by extranatomic bypass, aneurysm excision, and drainage. Am J Surg, 155(5):655–658.
10.
ChanFCrawfordECoselliJSafiHJWilliamsTWJr (1989). In situ prosthetic graft replacement for mycotic aneurysms of the aorta. Ann Thorac Surg, 47(2):193–203.
11.
MullerBWegenerOGrabitzKPillnyMThomasLSandmannW (2001). Mycotic aneurysms of the thoracic and abdominal aorta and iliac arteries: experience with anatomic and extra-anatomic repair in 33 cases. J Vasc Surg, 33(1):106–113.
12.
DakeMMillerDSembaCMitchellRMitchellRSWalkerPJLiddellRP (1994). Transluminal placement of endovascular stent-grafts for the treatment of descending thoracic aortic aneurysms. New Engl J Med, 331(26):1729–1734.
13.
ParodiJPalmazJCBaroneH (1991). Transfemoral intraluminal graft implantation for abdominal aortic aneurysms. Ann Vasc Surg, 5(6):491–499.
14.
MarinMVeithF (1995). Clinical applications of endovascular grafts in aortoiliac occlusive disease and vascular trauma. Cardiovasc Surg, 3(2):115–120.
