A Mycobacterium bovis Mycotic Abdominal Aortic Aneurysm Resulting From Bladder Cancer Treatment,Resection,and Reconstruction With a Cryopreserved Aortic Graft
Restricted accessResearch articleFirst published online January, 2013
A Mycobacterium bovis Mycotic Abdominal Aortic Aneurysm Resulting From Bladder Cancer Treatment,Resection,and Reconstruction With a Cryopreserved Aortic Graft
Mycotic abdominal aortic aneurysms (AAAs) are a clinical challenge for vascular surgeons due to their critical location, surrounding inflammation, risk of rupture, and danger of reinfection following treatment. We present a case of Mycobacterium bovis AAA in a 69-year-old male after treatment with intravesicular bacillus Calmette-Guérin (BCG) therapy for bladder carcinoma. The classical approach for mycotic AAA entails extra-anatomic reconstruction followed by resection with oversewing of the proximal and distal aortic stumps. Alternative in-line reconstruction options have also been advocated. This case illustrates a technically straightforward, durable, in-line repair within an infected field utilizing cryopreserved aortic allograft.
ShangPFKwongJWangZP. Intravesical bacillus calmette-guerin versus epirubicin for Ta and T1 bladder cancer. Cochrane Database Syst Rev. 2011;(5):CD006885.
2.
SchellhammerPFLadagaLEFillionMB. Bacillus calmette-guerin for superficial transitional cell carcinoma of the bladder. J Urol. 1986;135(2):261–264.
3.
HiguchiTShimizuMOwakiA. A possible mechanism of intravesical bcg therapy for human bladder carcinoma: involvement of innate effector cells for the inhibition of tumor growth. Cancer Immunol Immunother. 2009;58(8):1245–1255.
4.
AlexandroffABJacksonAMO'DonnellMAJamesK. Bcg immunotherapy of bladder cancer: 20 years on. Lancet. 1999;353(9165):1689–1694.
5.
HardingGELawlorDK: Ruptured mycotic abdominal aortic aneurysm secondary to mycobacterium bovis after intravesical treatment with bacillus calmette-guerin. J Vasc Surg. 2007;46(1):131–134.
6.
CoscasRArletJBBelhommeDFabianiJNPouchotJ. Multiple mycotic aneurysms due to mycobacterium bovis after intravesical bacillus calmette-guerin therapy. J Vasc Surg. 2009;50(5):1185–1190.
7.
MaundrellJFletcherSRobertsPSteinALambieM. Mycotic aneurysm of the aorta as a complication of bacillus calmette-guerin instillation. J R Coll Physicians Edinb. 2011;41(2):114–116.
8.
CostiniukCTSharapovAARoseGW. Mycobacterium bovis abdominal aortic and femoral artery aneurysms following intravesical bacillus calmette-guerin therapy for bladder cancer. Cardiovasc Pathol. 2010;19(2):e29–e32.
9.
WitjesJAVriesemaJLBrinkmanKBootsmaGBarentszJO. Mycotic aneurysm of the popliteal artery as a complication of intravesical BCG therapy for superficial bladder cancer. Case report and literature review. Urol Int. 2003;71(4):430–432.
10.
BornetPPujadeBLacaineF: Tuberculous aneurysm of the femoral artery: a complication of bacille calmette-guerin vaccine immunotherapy--a case report. J Vasc Surg. 1989;10(6):688–692.
11.
BlaisdellFWDematteiGAGauderPJ. Extraperitoneal thoracic aorta to femoral bypass graft as replacement for an infected aortic bifurcation prosthesis. Am J Surg. 1961;102:583–585.
12.
ClagettGPValentineRJHaginoRT. Autogenous aortoiliac/femoral reconstruction from superficial femoral-popliteal veins: feasibility and durability. J Vasc Surg. 1997;25(2):255–266.
13.
GuptaAKBandykDFJohnsonBL.In situ repair of mycotic abdominal aortic aneurysms with rifampin-bonded gelatin-impregnated dacron grafts: a preliminary case report. J Vasc Surg. 1996;24(3):472–476.
14.
Goeau-BrissonniereOMercierFNicolasMH: Treatment of vascular graft infection by in situ replacement with a rifampin-bonded gelatin-sealed Dacron graft. J Vasc Surg. 1994;19(4):739–741.
15.
BisdasTBredtMPichlmaierM. Eight-year experience with cryopreserved arterial homografts for the in situ reconstruction of abdominal aortic infections. J Vasc Surg. 2010;52(2):323–330.
16.
KiefferEGomesDChicheLFleronMHKoskasFBahniniA. Allograft replacement for infrarenal aortic graft infection: early and late results in 179 patients. J Vasc Surg. 2004;39(5):1009–1017.
17.
KiefferEBahniniAKoskasFRuotoloCLe BlevecDPlissonnierD.In situ allograft replacement of infected infrarenal aortic prosthetic grafts: results in forty-three patients. J Vasc Surg. 1993;17(2):349–355.
18.
BisdasTWilhelmiMHaverichATeebkenOE. Cryopreserved arterial homografts vs silver-coated dacron grafts for abdominal aortic infections with intraoperative evidence of microorganisms. J Vasc Surg. 2011;53(5):1274–1281.
