Mycotic Aneurysm in the Aortoiliac Area – Current Options for Treatment

Abstract

Background: Infection represents a less frequent cause for the development of an abdominal aortic aneurysm. The diagnosis is associated with a high risk of rapir progression and rupture. Case Reports: Case 1 is a female operated on urgently for a ruptured mycotic aneurysm of the abdominal aorta. After resection of the aneurysm, we performed in situ replacement using a rifampicin-soaked vascular prosthesis. In case 2, an asymptomatic aneurysm of the right iliac artery was treated by endovascular implantation of a stent-graft. Both patients were treated with antibiotics concurrently and are still alive. Discussion: The discussion deals with the up-to-date treatment modalities for mycotic aneurysms in the aorto-iliac region. The indication criteria must be adjusted individually. Conclusion: The prognosis of patients with a mycotic aneurysm depends particularly on an early diagnosis.

Zusammenfassung

Hintergrund: Infektionen sind nur selten Ursachen einer Aneurysmaentwicklung. Diese Diagnose ist jedoch mit einem hohen Progress- und Rupturrisiko verbunden. Patienten: Wir präsentieren die Kasuistik zweier Patienten. Die erste Patientin wurde bei bestehender infrarenalen Ruptur notfallmässig mit einer rifampicingetränkten Rohrprothese versorgt. Der zweite Patient erhielt bei symptomatischem Iliacaaneurysma einen Endograft. Ergebnisse: In der Diskussion werden die aktuellen Therapiemöglichkeiten im aorto-iliacalen Bereich besprochen. Schlussfolgerung: Die Prognose bei den Patienten mit mykotischen Aneurysmen hängt vor allem von einer frühzeitigen Diagnosebestimmung ab.

Schlüsselwörter

mykotische Aneurysma - in situ Prothese - Stentgraft - autologe Vena femoralis

Key words

mycotic aneurysm - in-situ prosthesis - stent graft - autologous femoral vein

• Literatur

• 1 Chen IM, Chang HH, Hsu CP et al. Ten-year experience with surgical repair of mycotic aortic aneurysm. J Chin Med Assoc 2005; 68: 265-271
• 2 Oderich GS, Panneton JM, Bower TC et al. Infected aortic aneurysms: aggressive presentation, complicated early outcome, but durable results. J Vasc Surg 2001; 34: 900-908
• 3 Karkos CD, Burnett C, Buckely H et al. Mycotic common iliac artery aneurysm complicating Methicillin-resistant Staphylococcus aureus bacteremia: an unusual cause of ureteric obstruction. Ann Vasc Surg 2005; 19: 904-908
• 4 McCready RA, Bryant MA, Divelbiss JL et al. Arterial Infections in the New Millenium: An Old Problem Revisited. Ann Vasc Surg 2006; 20: 590-595
• 5 Patra P, Ricco JB, Costargent A et al. Infected Aneurysms of Neck and Limb Arteries: A Retrospective Multicenter Study. Ann Vasc Surg 2001; 15: 197-205
• 6 Safar HA, Cina CS. Ruptured mycotic aneurysm of the popliteal artery. A case report and review of the literature. J Cardiovasc Surg 2001; 42: 237-240
• 7 Chiang WC, Tsai JC, Chen SY et al. Mycotic aneurysm caused by Streptococcus constellatus subspl. constellatus. J Clin Microb 2004; 42: 1826-1828
• 8 Leseche G, Castier Y, Petit MD et al. Long-term results of cryopreserved arterial allograft reconstruction in infected prosthetic grafts and mycotic aneurysms of the abdominal aorta. J Vasc Surg 2001; 34: 616-622
• 9 Patetsios PP, Shutze W, Holden B et al. Repair of a Mycotic aneurysm of the infrarenal aorta in a patient with HIV, using a Palmaz stent and autologous femoral vein graft. Ann Vasc Surg 2002; 16: 521-523
• 10 Šedivý P, Špaček M, El Samman K et al. Endovascular treatment of infected aortic aneurysm. Eur J Vasc Endovasc Surg 2012; 44: 385-394
• 11 Bergert H, Ockert D, Illert T et al. Aortic rupture due to Salmonella infection – surgical reconstructive options. EJVES Extra 2003; 5: 92-94
• 12 Gagnon J, Labbé R, Laroche B. Salmonella urinary tract infection: a vascular emergency. Can J Surg 2007; 50: 221-222
• 13 Cicconi V, Mannino S, Caminiti G et al. Salmonella aortic aneurysm: suggestions for diagnosis and therapy based on personal experience – a case report. Angiology 2004; 55: 701-705
• 14 Sessa C, Farah I, Voirin L et al. Infected Aneurysms of the Infrarenal Abdominal Aorta: Diagnostic Criteria and Therapeutic Strategy. Ann Vasc Surg 1997; 11: 453-463
• 15 Kim KW, Kim JH, Youn YN. Extra-anatomic bypass grafting after endovascular embolization for the treatment of mycotic aneurysm – 2 case reports –. Korean J Thorac Cardiovasc Surg 2011; 44: 189-192
• 16 Müller BT, Wegener OR, Grabitz K et al. Mycotic aneurysms of the thoracic and abdominal aorta and iliac arteries: Experience with anatomic and extra-anatomic repair in 33 cases. J Vasc Surg 2001; 33: 106-113
• 17 Dvořák M, Staffa R, Podlaha J et al. Rupturované mykotické aneuryzma břišní aorty řešené graftem z vena femoralis superficialis – kazuistika. Rozhl Chir 2009; 88: 11-13
• 18 Quinones-Baldrich WJ, Nene SM, Gelabert HA et al. Rupture of the perivisceral aorta: atherosclerotic versus mycotic aneurysm. Ann Vasc Surg 1997; 11: 331-341
• 19 Benjamin ME, Cohn EJ, Purtill WA et al. Arterial reconstruction with deep leg veins for the treatment of mycotic aneurysms. J Vasc Surg 1999; 30: 1004-1015
• 20 Staffa R, Kříž Z, Vlachovský R. Hluboká žíla dolní končetiny jako tepenná náhrada při řešení infekce cévní protézy. Rozhl Chir 2008; 87: 186-189
• 21 Staffa R. Náhrada infikované aortální protézy autologní femorální žilou včetně stavů po resekci AAA. Vask Med 2011; 3: 54-56
• 22 Koeppel TA, Gahlen J, Diehl S et al. Mycotic aneurysm of the abdominal aorta with retroperitoneal abscess: successful endovascular repair. J Vasc Surg 2004; 40: 164-166
• 23 Tiesenhausen K, Hessinger M, Tomka M et al. Endovascular treatment of mycotic aortic pseudoaneurysms with stent-grafts. Cardiovasc Intervent Radiol 2008; 31: 509-513
• 24 Pérez P, Esteban C, Martorell A et al. Combined treatment with open and endovascular surgery of a mycotic abdominal aortic aneurysm. EJVES Extra 2006; 11: 23-25
• 25 Kitamura T, Morota T, Motomura N et al. Management of infected grafts and aneurysms of the aorta. Ann Vasc Surg 2005; 19: 1-8
• 26 Pfister K, Krammer S, Janotta M et al. Ultrasound for surveillance after endovascular repair of abdominal aortic aneurysm – simple and safe?. Zentralbl Chir 2010; 135: 409-415
• 27 De Bast Y, Creemers E. Infection of an Abdominal Aortic Stent Graft with Suprarenal Attachment. Ann Vasc Surg 2006; 20: 736-738