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Li HL, Kwan KJS, Chan YC, Cheng SW. Contemporary Outcomes of Endovascular and Open Surgical Repair for Mycotic Aortic Aneurysms: A Systematic Review. Ann Vasc Surg 2024; 100:172-183. [PMID: 37898457 DOI: 10.1016/j.avsg.2023.08.039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Revised: 08/28/2023] [Accepted: 08/29/2023] [Indexed: 10/30/2023]
Abstract
BACKGROUND To perform a systematic review on contemporary outcomes of endovascular repair and open surgical repair (OSR) for the treatment of mycotic aortic aneurysm (MAA). METHODS A comprehensive literature search on the management of MAAs with endovascular repair or OSR was performed between January 1998 and January 2023. Patient demographics, early and late outcomes were analyzed with respect to treatment modality and MAA location. RESULTS Forty-eight articles were included, encompassing a total of 1,358 patients (75.8% male; mean age 66.9 years; 1,372 aneurysms) treated by open (49.8%) or endovascular (50.2%) repair. Salmonella spp., and Staphylococcus spp. were the most prevalent pathogens in Asian and European countries respectively. An increasing number of descending thoracic MAAs were managed by endovascular repair (27.9% vs. 12.8%). Early mortality rates for supra- and infra-renal MAAs managed by endovascular repair were lower than OSR (suprarenal 5.4% vs. 43.2%; infrarenal 1.8% vs. 16.7%). Overall, endovascular repair demonstrated lower intraoperative (1.0% vs. 1.8%) and early mortality (6.5% vs. 15.9) rates than OSR. However, endovascular repair was associated with higher late sepsis rate (5.7% vs. 0.9%) and reintervention rate (17.6% vs. 7.3%). Pooled survival rates at 1- and 5-year were similar between the 2 groups. CONCLUSIONS Current literature suggest that endovascular repair is an effective and safe alternative to OSR for descending thoracic, suprarenal, and infrarenal MAAs. However, endovascular repair is associated with higher risk of infection-related complications and reintervention during follow-up.
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Affiliation(s)
- Hai-Lei Li
- Division of Vascular Surgery, Department of Surgery, The University of Hong Kong - Shenzhen Hospital, Shenzhen, China
| | - Kristine J S Kwan
- Division of Vascular Surgery, Department of Surgery, The University of Hong Kong - Shenzhen Hospital, Shenzhen, China; Shanghai Medical College, Fudan University, Shanghai, China
| | - Yiu Che Chan
- Division of Vascular Surgery, Department of Surgery, The University of Hong Kong - Shenzhen Hospital, Shenzhen, China; Division of Vascular & Endovascular Surgery, Department of Surgery, University of Hong Kong Medical Centre, Queen Mary Hospital, Hong Kong, China.
| | - Stephen W Cheng
- Division of Vascular Surgery, Department of Surgery, The University of Hong Kong - Shenzhen Hospital, Shenzhen, China; Division of Vascular & Endovascular Surgery, Department of Surgery, University of Hong Kong Medical Centre, Queen Mary Hospital, Hong Kong, China
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2
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Daskalov AT. Endovascular Treatment of a Contained Rupture of a Penetrating Aortic Ulcer in a Young Patient. Cureus 2024; 16:e56428. [PMID: 38638720 PMCID: PMC11024580 DOI: 10.7759/cureus.56428] [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] [Accepted: 03/18/2024] [Indexed: 04/20/2024] Open
Abstract
Penetrating aortic ulcer (PAU) is a component of acute aortic syndromes (AASs), encompassing a range of potentially life-threatening aortic conditions such as dissection, intramural hematoma (IMH), and PAU itself. Ruptured PAU constitutes an emergency requiring surgical intervention. Here, we present a case involving a 47-year-old male patient admitted to our emergency department due to severe abdominal pain, malaise, and tenderness of the abdominal wall, which commenced abruptly several hours prior. An emergency CT scan revealed a large pseudoaneurysm of the infrarenal abdominal aorta, which was found with moderate atherosclerosis and no evidence of other dilated or aneurysmal segments. The patient underwent successful endovascular treatment and was discharged four days later without complications. Follow-up examination after two months demonstrated a patent graft and reduction of the aneurysmal sac.
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3
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Girardi N, Denney R, LaGrone L. Superior mesenteric artery mycotic aneurysm repaired with bifurcated saphenous vein graft. J Vasc Surg Cases Innov Tech 2023; 9:101244. [PMID: 37799837 PMCID: PMC10547743 DOI: 10.1016/j.jvscit.2023.101244] [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: 01/30/2023] [Accepted: 05/26/2023] [Indexed: 10/07/2023] Open
Abstract
A mycotic aneurysm of the superior mesenteric artery caused by Enterococcus faecalis was successfully treated with aneurysmectomy and reconstruction with a bifurcated saphenous vein graft. A 49-year-old man with a history of type 2 diabetes mellitus and a recent left transmetatarsal amputation for osteomyelitis presented to the emergency department with severe abdominal pain, an unexplained 30-lb weight loss, and wound dehiscence. Computed tomography angiography showed an aneurysm of the superior mesenteric artery and a splenic abscess. The patient underwent splenectomy, surgical resection of the aneurysm, and reconstruction with a bifurcated saphenous vein. Follow-up revealed normal gastrointestinal function and graft patency.
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Affiliation(s)
- Nicholas Girardi
- School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO
| | - Richard Denney
- Vascular Surgery, UCHealth Medical Center of the Rockies, Loveland, CO
| | - Lacey LaGrone
- Trauma Acute Care Surgery, UCHealth Medical Center of the Rockies, Loveland, CO
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4
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Tehrani N, Will S, Halandras P. Endovascular repair of a Bacillus Calmette-Guerin mycotic aortic aneurysm. J Vasc Surg Cases Innov Tech 2022; 8:570-573. [PMID: 36248393 PMCID: PMC9556591 DOI: 10.1016/j.jvscit.2022.08.018] [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: 04/20/2022] [Accepted: 08/19/2022] [Indexed: 11/23/2022] Open
Abstract
Bacillus Calmette-Guérin (BCG) is an attenuated form of Mycobacterium bovis used for intravesical treatment of bladder carcinoma. Aortic infection has been rare. In the present report, we have described the case of a patient with an infrarenal mycotic aortic pseudoaneurysm and para-aortic abscess after intravesical bacillus Calmette-Guérin and cystectomy. Sampling of the abscess demonstrated acid-fast bacilli. Given the hostile anatomy of the abdomen, he was offered endovascular aortic repair. A thoracic endograft was used to cover the lesion. The patient was discharged on postoperative day 2 without incident. He was seen at 1 and 6 months with resolution of his pseudoaneurysm found on the imaging studies. The technique shows promise for stabilizing such lesions with close surveillance.
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Matsui K, Takahashi K, Tashiro M, Tanaka T, Izumikawa K, Miura T, Eishi K, Furumoto A, Ariyoshi K. Clinical and microbiological characteristics and challenges in diagnosing infected aneurysm: a retrospective observational study from a single center in Japan. BMC Infect Dis 2022; 22:585. [PMID: 35773645 PMCID: PMC9245259 DOI: 10.1186/s12879-022-07567-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2022] [Accepted: 06/23/2022] [Indexed: 11/10/2022] Open
Abstract
Background It is challenging to diagnose infected aneurysm in the early phase. This study aimed to describe the clinical and microbiological characteristics of infected aneurysm, and to elucidate the difficulties in diagnosing the disease. Methods Forty-one cases of infected aneurysm were diagnosed in Nagasaki University Hospital from 2005 to 2019. Information on clinical and microbiological characteristics, radiological findings, duration of onset, and type of initial computed tomography (CT) imaging conditions were collected. Factors related to diagnostic delay were analyzed by Fisher’s exact test for categorical variables or by the Wilcoxon rank-sum test for continuous variables. Results Pathogens were identified in 34 of 41 cases; the pathogens were Gram-positive cocci in 16 cases, Gram-negative rods in 13 cases, and others in five cases. Clinical characteristics did not differ in accordance with the identified bacteria. At the time of admission, 16 patients were given different initial diagnoses, of which acute pyelonephritis (n = 5) was the most frequent. Compared with the 22 patients with an accurate initial diagnosis, the 19 initially misdiagnosed patients were more likely to have been examined by plain CT. The sensitivities of plain CT and contrast-enhanced CT were 38.1% and 80.0%, respectively. Conclusions In cases of infected aneurysm, diagnostic delay is attributed to non-specific symptoms and the low sensitivity of plain CT. Clinical characteristics of infected aneurysm mimic various diseases. Contrast-enhanced CT should be considered if infected aneurysm is suspected.
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Affiliation(s)
- Kohsuke Matsui
- Department of Infectious Diseases, Nagasaki University Hospital, 1-7-1 Sakamoto, Nagasaki-shi, Nagasaki, 852-8501, Japan.
| | - Kensuke Takahashi
- Department of Infectious Diseases, Nagasaki University Hospital, 1-7-1 Sakamoto, Nagasaki-shi, Nagasaki, 852-8501, Japan
| | - Masato Tashiro
- Infection Control and Education Center, Nagasaki University Hospital, 1-7-1 Sakamoto, Nagasaki-shi, Nagasaki, 852-8501, Japan
| | - Takeshi Tanaka
- Infection Control and Education Center, Nagasaki University Hospital, 1-7-1 Sakamoto, Nagasaki-shi, Nagasaki, 852-8501, Japan
| | - Koichi Izumikawa
- Infection Control and Education Center, Nagasaki University Hospital, 1-7-1 Sakamoto, Nagasaki-shi, Nagasaki, 852-8501, Japan
| | - Takashi Miura
- Department of Cardiovascular Surgery, Nagasaki University Hospital, 1-7-1 Sakamoto, Nagasaki-shi, Nagasaki, 852-8501, Japan
| | - Kiyoyuki Eishi
- Department of Cardiovascular Surgery, Nagasaki University Hospital, 1-7-1 Sakamoto, Nagasaki-shi, Nagasaki, 852-8501, Japan
| | - Akitsugu Furumoto
- Infectious Diseases Experts Training Center, Nagasaki University Hospital, 1-7-1 Sakamoto, Nagasaki-shi, Nagasaki, 852-8501, Japan
| | - Koya Ariyoshi
- Department of Infectious Diseases, Nagasaki University Hospital, 1-7-1 Sakamoto, Nagasaki-shi, Nagasaki, 852-8501, Japan
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Lee KT, Leong KN, Chow TS, Wong PS. Unusual cause of hemorrhagic pleural effusion: A case report. World J Clin Infect Dis 2022; 12:41-46. [DOI: 10.5495/wjcid.v12.i1.41] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Revised: 03/06/2022] [Accepted: 04/04/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Infected aortic aneurysms are uncommon and difficult to treat. We present a case of infected aortic aneurysm with recurrent nontyphoidal Salmonella bacteremia.
CASE SUMMARY A 68-year-old gentleman presented with non-specific symptoms and was found to have nontyphoidal Salmonella bacteremia and was treated with intravenous ceftriaxone. However his condition did not improve, and he developed a multiloculated right pleural effusion. Thoracocentesis was done to drain hemorrhagic pleural fluid. Chest computed tomography demonstrated descending thoracic aorta saccular aneurysm with periaortic hematoma likely due to recent bleed and extending to the right pleural cavity. He was referred to cardiothoracic surgery team and was planned for medical therapy in view of hemodynamic stability and no evidence of active leakage. He completed intravenous antibiotic for 5 wk and refused surgical intervention. Unfortunately, he was admitted twice for recurrent nontyphoidal Salmonella bacteremia. Finally, he agreed for surgical intervention and underwent endovascular aortic repair 3 mo later. Postoperatively, his condition remained stable with no recurrence of infection.
CONCLUSION Our case highlights the importance of high index of suspicion of infected aortic aneurysm in patients with Salmonella bacteremia with high-risk factors such as atherosclerosis.
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Affiliation(s)
- Kee Tat Lee
- Department of Medicine, Hospital Sultanah Bahiyah, Alor Setar 05460, Kedah, Malaysia
| | - Kar Nim Leong
- Infectious Disease Unit, Department of Medicine, Hospital Pulau Pinang, Georgetown 10990, Pulau Pinang, Malaysia
| | - Ting Soo Chow
- Infectious Disease Unit, Department of Medicine, Hospital Pulau Pinang, Georgetown 10990, Pulau Pinang, Malaysia
| | - Peng Shyan Wong
- Infectious Disease Unit, Department of Medicine, Hospital Pulau Pinang, Georgetown 10990, Pulau Pinang, Malaysia
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Berndsen RH, Hulshof PB, van Meer MP, Saleem BR, Scholtes VP, The RM, Jongkind V, Yeung KK. Capnocytophaga canimorsus Mycotic Aortic Aneurysm After a Dog Bite. EJVES Vasc Forum 2022; 55:64-67. [PMID: 35620416 PMCID: PMC9126945 DOI: 10.1016/j.ejvsvf.2022.04.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2021] [Revised: 03/04/2022] [Accepted: 04/22/2022] [Indexed: 10/25/2022] Open
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Cryopreserved venous allograft in the treatment of a mycotic abdominal aortic aneurysm caused by group B Streptococcus. J Vasc Surg Cases Innov Tech 2022; 8:9-12. [PMID: 35024523 PMCID: PMC8731693 DOI: 10.1016/j.jvscit.2021.10.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Accepted: 10/29/2021] [Indexed: 11/22/2022] Open
Abstract
We report a case of a mycotic abdominal aortic aneurysm caused by invasive group B streptococcus. Given the anatomical suitability with healthy segments of aortoiliac vessels, in situ repair was performed. A cryopreserved femoral vein graft was chosen because of risks of graft reinfection and negated the need for bilateral femoral vein harvest. The patient remained clinically well and the graft patent with no concerns at 6 months of follow-up. A review of literature on group B Streptococcus aortitis was performed.
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9
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Mycotic abdominal aorta aneurysm with duodenal invasion. ANGIOLOGIA 2022. [DOI: 10.20960/angiologia.00415] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
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10
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Flynn D, Ogi A, Subedi S, Langton J, Choong K, O'Donnell J. Mycotic aortic aneurysm formation following intravesical BCG treatment for transitional cell carcinoma of the bladder. BMJ Case Rep 2021; 14:e246389. [PMID: 34815228 PMCID: PMC8611418 DOI: 10.1136/bcr-2021-246389] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/23/2021] [Indexed: 11/04/2022] Open
Abstract
Mycotic aneurysms are rare and if left untreated, can have devastating outcomes. In this case, a 72-year-old man presented to hospital with fevers, night sweats and abdominal pain. A CT scan revealed the development an infrarenal pseudoaneurysm over the course of 8 weeks, increasing from 2.8 cm to a 3.1 cm. The aneurysm was not present on a CT scan performed 6 months earlier. The patient underwent an emergency endovascular repair of the aortic aneurysm (EVAR) and was placed on broad-spectrum antibiotics. Intra-aortic blood cultures aspirated adjacent to the aneurysm and tissue biopsy confirmed tuberculosis bovis as the cause of the mycotic aneurysm. The patient had been treated with intravesical BCG for transitional cell carcinoma of the bladder several months prior. The patient was treated with an extended course of antituberculosis medication. He recovered well and was back to his baseline function within weeks.
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Affiliation(s)
- David Flynn
- Vascular Surgery Department, Sunshine Coast Hospital and Health Service, Birtinya, Queensland, Australia
| | - Akihiro Ogi
- Infectious Diseases Department, Sunshine Coast Hospital and Health Service, Birtinya, Queensland, Australia
| | - Shradha Subedi
- Infectious Diseases Department, Sunshine Coast Hospital and Health Service, Birtinya, Queensland, Australia
| | - Jonathan Langton
- Interventional Radiology Department, Sunshine Coast Hospital and Health Service, Birtinya, Queensland, Australia
| | - Keat Choong
- Infectious Diseases Department, Sunshine Coast Hospital and Health Service, Birtinya, Queensland, Australia
| | - Jill O'Donnell
- Vascular Surgery Department, Sunshine Coast Hospital and Health Service, Birtinya, Queensland, Australia
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11
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Zad M, Do CN, Teo A, Dixon E, Welch C, Karamatic R. Concurrent cholecystoduodenal fistula and primary aortoenteric fistula. Oxf Med Case Reports 2021; 2021:omab102. [PMID: 34729200 PMCID: PMC8557450 DOI: 10.1093/omcr/omab102] [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: 05/09/2021] [Revised: 07/31/2021] [Accepted: 09/22/2021] [Indexed: 11/12/2022] Open
Abstract
Bilioenteric fistulae are a rare complication and can pose a diagnostic challenge owing to non-specific symptomology. When occurring with an aortoenteric fistula, it represents a rare and potentially life-threatening disease state. We present the case of a 77-year-old gentleman initially treated as presumed ascending cholangitis. This was complicated by upper gastrointestinal bleeding secondary to an aortoenteric fistula and cholecystoduodenal fistula.
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Affiliation(s)
- Mohammadali Zad
- Gastroenterology, Caboolture Hospital, Caboolture 4510, Australia
| | - Cuong N Do
- General Medicine, Metro South Health Service, Brisbane 4102, Australia
| | - Andrew Teo
- Gastroenterology, Caboolture Hospital, Caboolture 4510, Australia
| | - Eliza Dixon
- General Medicine, Townsville Hospital and Health Service, Townsville 4814, Australia
| | - Christine Welch
- Gastroenterology, Townsville Hospital and Health Service, Townsville 4814, Australia
| | - Rozemary Karamatic
- Gastroenterology, Townsville Hospital and Health Service, Townsville 4814, Australia
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12
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Salmonella Aortitis Related to Rheumatoid Arthritis. INFECTIOUS DISEASES IN CLINICAL PRACTICE 2021. [DOI: 10.1097/ipc.0000000000001047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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13
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Bunde SG, Osigwe CC, Hager E. A Case Report: Ruptured Popliteal Aneurysm Caused by Haemophilus Influenzae Infection. Ann Vasc Surg 2021; 79:442.e1-442.e4. [PMID: 34655753 DOI: 10.1016/j.avsg.2021.08.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Revised: 07/28/2021] [Accepted: 08/03/2021] [Indexed: 11/27/2022]
Abstract
Mycotic aneurysms arise from infection of an arterial wall secondary to septic emboli from endocarditis. Although rare, most mycotic aneurysms involve the abdominal aorta, with Staphylococcus aureus and Salmonella spp being the most common causative organisms. We report a case of an 81-year-old woman with a ruptured mycotic popliteal aneurysm from Haemophilus influenzae infection.
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Affiliation(s)
- Sophia G Bunde
- University of Pittsburgh School of Medicine, Pittsburgh, PA.
| | | | - Eric Hager
- University of Pittsburgh School of Medicine, Pittsburgh, PA; Department of Vascular Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA
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Systematic Review and Meta-Analysis of Outcomes Following Endovascular and Open Repair for Infective Native Aortic Aneurysms. Ann Vasc Surg 2021; 79:348-358. [PMID: 34644648 DOI: 10.1016/j.avsg.2021.07.025] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Revised: 07/02/2021] [Accepted: 07/04/2021] [Indexed: 02/08/2023]
Abstract
OBJECTIVE The aim of our systematic review and meta-analysis was to demonstrate the clinical outcomes of open surgical repair (OSR) and endovascular aneurysm repair (EVAR) for infective native aortic aneurysms (INAAs). METHODS MEDLINE, Embase, and Cochrane Databases were searched for articles reporting OSR and/or EVAR repair of INAA. The methodological quality of included studies was assessed by the Newcastle-Ottawa scale and Moga-Score. Random-effects models were used to calculate the pooled measures. RESULTS A total of 34 studies were included, with 22 studies reporting OSR alone, 6 studies reporting EVAR alone and 6 comparative studies for INAAs. The pooled estimates of infection-related complications (IRCs) were 8.2% (95% CI 4.9%-12.2%) in OSR cohort and 23.2% (95% CI 16.1%-31.0%) in EVAR cohort. EVAR was associated with a significantly increased risk of IRCs compared with OSR during follow-up (OR 1.9, 95% CI 1.0-3.7). As for survival outcomes, the summary estimate rate of all cause 30-day, 3-month and 1-year mortality in OSR cohort were 11.7% (95% CI 7.7%-16.1%), 21.6% (95%CI 16.3%-27.4%) and 28.3% (95% CI 20.5%-36.7%; I2=50.47%), respectively. For EVAR cohort, the summary estimate rate of all cause 30-day, 3-month and 1-year mortality were 4.9% (95% CI 1.1%-10.4%), 9.4% (95% CI 2.7%-18.7%) and 22.2% (95% CI 12.4%-33.7%), respectively. EVAR was associated with a significantly decreased of 30-day mortality (OR 0.2, 95% CI 0.1-0.6). However, no difference was found between EVAR and OSR in 3-month (OR 0.2, 95% CI 0-1.1), 1-year all-cause mortality (OR 0.4, 95% CI 0.1-1.1) or aneurysm-related mortality (OR 1.4, 95% CI 0.5-3.9). Moreover, no difference of incidence of reintervention was observed (OR 2.6, 95% CI 0.9-7.7; I2=53.7%) between two groups. CONCLUSIONS EVAR could provide better short-term survival than OSR in patients with INAAs. However, patients undergoing EVAR suffered from higher risks of IRCs. EVAR could be considered as an alternative for low-risk patients with well-controlled infections or patients considered high-risk for open reconstruction.
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Shchetynska-Marinova T, Amendt K, Sadick M, Keese M, Sigl M. Aortitis - An Interdisciplinary Challenge. In Vivo 2021; 35:41-52. [PMID: 33402448 DOI: 10.21873/invivo.12230] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2020] [Revised: 10/15/2020] [Accepted: 10/21/2020] [Indexed: 12/24/2022]
Abstract
The term 'aortitis' comprises a heterogeneous spectrum of diseases, with varied etiology and clinical presentations, whose common characteristic is the inflammation of the aortic wall. Since aortitis can mimic almost all common cardiovascular disorders, its clinical recognition remains a challenge. Some cases of aortitis remain undetected for a long time and may be diagnosed after severe life-threatening complications have already arisen. The diagnosis of aortitis is based on the presence of homogeneous circumferential thickening of the aortic wall detected on aortic imaging, or typical histological features in combination with clinical findings and laboratory parameters. Management of aortitis is usually conservative (immunosuppressive drugs in noninfectious aortitis; antimicrobial drugs in infectious). However, if vascular complications such as aortic aneurysm, rupture, or steno-occlusive events appear, aortic surgery or endovascular therapy may be required. This review article summarizes the current knowledge regarding the etiology, clinical presentation, diagnosis, and treatment of inflammatory diseases of the aorta to promote better clinical management of these entities.
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Affiliation(s)
- Tetyana Shchetynska-Marinova
- First Department of Medicine, University Medical Centre Mannheim, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - Klaus Amendt
- Vascular Center Oberrhein, Internal Medicine I, Diakonissenkrankenhaus Mannheim, Mannheim, Germany
| | - Maliha Sadick
- Clinic for Radiology and Nuclear Medicine, University Medical Center Mannheim, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - Michael Keese
- Department of Vascular Surgery, University Medical Centre Mannheim, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - Martin Sigl
- First Department of Medicine, University Medical Centre Mannheim, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany;
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16
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Kovacs-Litman A, Gold WL. Faux anévrisme de l’artère brachiale chez un utilisateur de drogues injectables. CMAJ 2021; 193:E935-E936. [PMID: 34860695 PMCID: PMC8248461 DOI: 10.1503/cmaj.201843-f] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Affiliation(s)
- Adam Kovacs-Litman
- Département de médecine (Gold, Kovacs-Litman), Université de Toronto; Divisions de médecine interne générale et d'infectiologie (Gold), Réseau universitaire de santé, Toronto, Ont.
| | - Wayne L Gold
- Département de médecine (Gold, Kovacs-Litman), Université de Toronto; Divisions de médecine interne générale et d'infectiologie (Gold), Réseau universitaire de santé, Toronto, Ont
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17
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Zhang N, Xiong W, Li Y, Mao Q, Xu S, Zhu J, Sun Z, Sun L. Imaging features of mycotic aortic aneurysms. Quant Imaging Med Surg 2021; 11:2861-2878. [PMID: 34079747 DOI: 10.21037/qims-20-941] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Infectious aortitis (IA) is a rare and life-threatening cardiovascular disease. Early diagnosis and timely intervention are crucial for reducing mortality associated with mycotic aortic aneurysms (MAAs); however, early diagnosis is challenging due to the nonspecific symptoms. Some cases are diagnosed at an advanced stage or after developing complications, such as rupture or aortic fistula. Current state-of-the-art imaging modalities-including computed tomography (CT), magnetic resonance imaging (MRI), and 18F-fluorodeoxyglucose (FDG) positron emission tomography (PET)/CT-can detect infected aneurysms in clinically suspicious cases. MAA features on imaging include lobulated pseudoaneurysm, indistinct irregular arterial wall, perianeurysmal gas, perianeurysmal edema, perianeurysmal soft tissue mass, aneurysmal thrombosis, and high metabolic activity with increased uptake of FDG. Enlarged lymph nodes are often found adjacent to the aneurysm, while iliopsoas abscess (IPA), spondylitis, and aortic fistulas are commonly associated complications. After surgery or endovascular repair, radiological features-including ectopic gas, peri-graft fluid, thickening of adjacent bowel, pseudoaneurysm formed at the graft anastomosis, and increased uptake of FDG-may indicate an infection of aortic graft. This article provides an overview of the clinical and imaging features of MAAs. Thus, familiarity with the imaging appearances of MAAs may assist radiologists in the diagnosis and facilitation of timely treatment.
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Affiliation(s)
- Nan Zhang
- Department of Radiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Wei Xiong
- Department of Respiration, First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Yu Li
- Department of Radiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Qinxiang Mao
- Department of Radiology, Longtan Hospital of Guangxi Zhuang Autonomous Region, Liuzhou, China
| | - Shangdong Xu
- Department of Cardiovascular Surgery, Beijing Aortic Disease Centre, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart Lung and Blood Vessel Diseases, Beijing Engineering Research Centre for Vascular Prostheses, Beijing, China
| | - Junming Zhu
- Department of Cardiovascular Surgery, Beijing Aortic Disease Centre, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart Lung and Blood Vessel Diseases, Beijing Engineering Research Centre for Vascular Prostheses, Beijing, China
| | - Zhonghua Sun
- Discipline of Medical Radiation Science, Curtin Medical School, Curtin University, Perth, Australia
| | - Lizhong Sun
- Department of Cardiovascular Surgery, Beijing Aortic Disease Centre, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart Lung and Blood Vessel Diseases, Beijing Engineering Research Centre for Vascular Prostheses, Beijing, China
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18
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Eke UA, Doub JB, Chua JV. Campylobacter fetus aortitis in a patient with HIV. IDCases 2021; 25:e01169. [PMID: 34094867 PMCID: PMC8167207 DOI: 10.1016/j.idcr.2021.e01169] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Revised: 05/18/2021] [Accepted: 05/19/2021] [Indexed: 02/07/2023] Open
Abstract
A 36-year-old man with well controlled HIV developed Campylobacter fetus aortitis. To prevent aortic rupture, emergent surgical resection and neo-aortoiliac replacement with his left femoral vein was conducted. After surgical intervention, he was successfully treated with intravenous ertapenem for 6 weeks followed by oral amoxicillin for 3 months.
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Affiliation(s)
- Uzoamaka A Eke
- Division of Clinical Care and Research, Institute of Human Virology, University of Maryland School of Medicine, Baltimore, MD, USA
| | - James B Doub
- Division of Clinical Care and Research, Institute of Human Virology, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Joel V Chua
- Division of Clinical Care and Research, Institute of Human Virology, University of Maryland School of Medicine, Baltimore, MD, USA
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19
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Culture-Negative Mycotic Aortic Aneurysms Probably Have a Less Severe Clinical Nature Than Culture-Positive Counterparts. Ann Vasc Surg 2021; 75:150-161. [PMID: 33831517 DOI: 10.1016/j.avsg.2021.03.018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Revised: 02/14/2021] [Accepted: 03/01/2021] [Indexed: 11/24/2022]
Abstract
BACKGROUND Mycotic aortic aneurysm constitutes a potentially devastating disease that necessitates prompt suspicion and diagnosis. There is no exact consensus for treatment, but removal of infected tissues and prolonged use of antimicrobials based on the identified causative microorganisms seem widely acceptable and have been similarly practiced worldwide. However, some patients still show no identified microorganisms. In this study, we sought to determine whether there are any clinical significance or differences of note in culture-negative mycotic aortic aneurysms. METHODS Between October 2003 and August 2018, 71 patients were identified as treated for mycotic aortic aneurysms at a single tertiary institution. Review of medical records and imaging studies were completed to collect the following information: demographics, previous medical/surgical history regarding potential infection sources, laboratory and radiologic findings, clinical presentations, treatment method, and morbidity and mortality rates. For analysis, patients were categorized into two groups: the blood and/or tissue culture-positive (CP) group and the blood and/or tissue culture-negative (CN) group. The latter was further divided as CN with identified microorganism by molecular biologic methods [CN(+)] and CN with no identified microorganism [CN(-)]. RESULTS More patients in the CP group were symptomatic than were in the CN(+) group (100% vs. 80%; P = 0.034). However, identification of causative microorganisms did not result in a difference in symptom status upon comparing the [CP + CN(+)] and [CN(-)] groups. Inflammatory markers were the most elevated in the CP group and least elevated in the CN(-) group. The aneurysm growth rate seemed slower in the CN(-) group than in the CN(+) and CP groups (1.3 vs. 3.4 vs. 9 mm/month respectively). Aneurysm rupture at initial presentation was more prevalent in the CP group (33.3%). 18F-Fluorodeoxyglucose-positron emission tomography showed increased uptake regardless of whether or not the microorganisms were identified. Early mortality and disease-specific mortality rates during the follow-up period were higher in the CP group but without statistical significance. CONCLUSIONS Compared with the CP group, the CN groups appeared clinically less severe, and also exhibited a relatively less devastating course as exhibited by the slower aneurysm expansion rate and smaller number of ruptured aneurysms at the initial presentation.
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20
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Kovacs-Litman A, Gold WL. Pseudoaneurysm of the brachial artery in a patient who uses intravenous drugs. CMAJ 2021; 193:E448. [PMID: 33782172 PMCID: PMC8099163 DOI: 10.1503/cmaj.201843] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Affiliation(s)
- Adam Kovacs-Litman
- Department of Medicine (Gold, Kovacs-Litman), University of Toronto; Divisions of General Internal Medicine and Infectious Diseases (Gold), University Health Network, Toronto, Ont.
| | - Wayne L Gold
- Department of Medicine (Gold, Kovacs-Litman), University of Toronto; Divisions of General Internal Medicine and Infectious Diseases (Gold), University Health Network, Toronto, Ont
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21
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Do CN, Mar EO, Sim B, Looke D. Primary aortoduodenal fistula and chronic Q fever infection. BMJ Case Rep 2021; 14:14/2/e238373. [PMID: 33542018 PMCID: PMC7868177 DOI: 10.1136/bcr-2020-238373] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
We report a case of chronic Q fever presenting with catastrophic bleeding from an infected abdominal aortic aneurysm causing a primary aortoduodenal fistula in an 80-year-old retired farmer. This presentation is rarely reported in literature and only through case reports. Early diagnosis and definitive surgery were critical to a successful outcome. Serological diagnosis of Q fever was initiated on the patient's past exposure to animal reservoirs. Complicating the case was ongoing gastrointestinal bleeding postsurgery, with multiple endoscopies undertaken before a culprit remnant fistula was found. This case highlights the value in considering Coxiella burnetii as an underlying cause in patients with known risk factors presenting with primary aortoduodenal fistulas. Though rare, it represents a readily treatable cause.
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Affiliation(s)
- Cuong Nghi Do
- Department of Infectious Diseases, Princess Alexandra Hospital, Brisbane, Queensland, Australia
| | - Ethan Oskar Mar
- Department of Infectious Diseases, Princess Alexandra Hospital, Brisbane, Queensland, Australia
| | - Beatrice Sim
- Department of Infectious Diseases, Princess Alexandra Hospital, Brisbane, Queensland, Australia
| | - David Looke
- Department of Infectious Diseases, Princess Alexandra Hospital, Brisbane, Queensland, Australia
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22
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Rajendra N, Sebastian J, Reddy A, Kumar A, Ayappan MK, Mathur K, Raju R. Mycotic aortic aneurysm caused by Acinetobacter baumannii complex: A rare case. INDIAN JOURNAL OF VASCULAR AND ENDOVASCULAR SURGERY 2021. [DOI: 10.4103/ijves.ijves_8_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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23
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Dong YH, Chang CH, Wang JL, Wu LC, Lin JW, Toh S. Association of Infections and Use of Fluoroquinolones With the Risk of Aortic Aneurysm or Aortic Dissection. JAMA Intern Med 2020; 180:1587-1595. [PMID: 32897358 PMCID: PMC7489369 DOI: 10.1001/jamainternmed.2020.4192] [Citation(s) in RCA: 49] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
IMPORTANCE Prior observational studies have suggested that fluoroquinolone use may be associated with more than 2-fold increased risk of aortic aneurysm or aortic dissection (AA/AD). These studies, however, did not fully consider the role of coexisting infections and the risk of fluoroquinolones relative to other antibiotics. OBJECTIVE To estimate the risk of AA/AD associated with infections and to assess the comparative risk of AA/AD associated with fluoroquinolones vs other antibiotics with similar indication profiles among patients with the same types of infections. DESIGNS, SETTINGS, AND PARTICIPANTS This nested case-control study identified 21 651 176 adult patients from a nationwide population-based health insurance claims database from January 1, 2009, to November 30, 2015. Each incident case of AA/AD was matched with 10 control individuals by age, sex, and follow-up duration in the database using risk-set sampling. Analysis of the data was conducted from April 2019 to March 2020. EXPOSURES Infections and antibiotic use within a 60-day risk window before the occurrence of AA/AD. MAIN OUTCOMES AND MEASURES Conditional logistic regression was used to estimate the odds ratios (ORs) and 95% CIs comparing infections for which fluoroquinolones are commonly used with no infection within a 60-day risk window before outcome occurrence, adjusting for baseline confounders and concomitant antibiotic use. The adjusted ORs comparing fluoroquinolones with antibiotics with similar indication profiles within patients with indicated infections were also estimated. RESULTS A total of 28 948 cases and 289 480 matched controls were included (71.37% male; mean [SD] age, 67.41 [15.03] years). Among these, the adjusted OR of AA/AD for any indicated infections was 1.73 (95% CI, 1.66-1.81). Septicemia (OR, 3.16; 95% CI, 2.63-3.78) and intra-abdominal infection (OR, 2.99; 95% CI, 2.45-3.65) had the highest increased risk. Fluoroquinolones were not associated with an increased AA/AD risk when compared with combined amoxicillin-clavulanate or combined ampicillin-sulbactam (OR, 1.01; 95% CI, 0.82-1.24) or with extended-spectrum cephalosporins (OR, 0.88; 95% CI, 0.70-1.11) among patients with indicated infections. The null findings for fluoroquinolone use remained robust in different subgroup and sensitivity analyses. CONCLUSIONS AND RELEVANCE These results highlight the importance of accounting for coexisting infections while examining the safety of antibiotics using real-world data; the findings suggest that concerns about AA/AD risk should not deter fluoroquinolone use for patients with indicated infections.
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Affiliation(s)
- Yaa-Hui Dong
- Faculty of Pharmacy, National Yang-Ming University School of Pharmaceutical Science, Taipei, Taiwan.,Institute of Public Health, National Yang-Ming University School of Medicine, Taipei, Taiwan
| | - Chia-Hsuin Chang
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.,Department of Medicine, National Taiwan University College of Medicine, Taipei, Taiwan.,Institute of Epidemiology and Preventive Medicine, National Taiwan University College of Public Health, Taipei, Taiwan
| | - Jiun-Ling Wang
- Department of Internal Medicine, National Cheng Kung University Hospital, Tainan, Taiwan.,Department of Medicine, National Cheng Kung University Medical College, Tainan, Taiwan
| | - Li-Chiu Wu
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Jou-Wei Lin
- Department of Medicine, National Taiwan University College of Medicine, Taipei, Taiwan.,Department of Internal Medicine, National Taiwan University Hospital Yunlin Branch, Douliou City, Yunlin County, Taiwan.,Cardiovascular Center, National Taiwan University Hospital Yunlin Branch, Douliou City, Yunlin County, Taiwan
| | - Sengwee Toh
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts
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24
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Liu QS, Raney B, Harji F. Impending rupture of mycotic aortic aneurysm infected with Streptococcus equi subspecies zooepidemicus. BMJ Case Rep 2020; 13:13/8/e235002. [PMID: 32843405 DOI: 10.1136/bcr-2020-235002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Streptococcus equi subspecies zooepidemicus is a beta-haemolytic, group C streptococcal bacterium. Although it is an opportunistic pathogen commonly found in horses, transmission to human can lead to severe infections. Here, we present a patient with S. equi subspecies zooepidemicus bacteraemia and consequent development of mycotic aneurysms.
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Affiliation(s)
- Qiuying Selina Liu
- Internal Medicine, University of New Mexico, Albuquerque, New Mexico, USA
| | - Brannon Raney
- Internal Medicine, University of New Mexico, Albuquerque, New Mexico, USA.,Internal Medicine, New Mexico VA Health Care System, Albuquerque, New Mexico, USA
| | - Farzana Harji
- Internal Medicine, University of New Mexico, Albuquerque, New Mexico, USA.,Internal Medicine, New Mexico VA Health Care System, Albuquerque, New Mexico, USA
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25
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Wang C, Zhao J, Zhang H, Lee YK, Zhai Q, Chen W. Roles of intestinal bacteroides in human health and diseases. Crit Rev Food Sci Nutr 2020; 61:3518-3536. [PMID: 32757948 DOI: 10.1080/10408398.2020.1802695] [Citation(s) in RCA: 53] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Bacteroides, an abundant genus in the intestines of mammals, has been recently considered as the next generation probiotics (NGP) candidate due to its potential role in promoting host health. However, the role of Bacteroides in the development of intestinal dysfunctions such as diarrhea, inflammatory bowel disease, and colorectal cancer should not be overlooked. In the present study, we focused on nine most widely occurred and abundant Bacteroides species and discussed their roles in host immunity, glucose and lipid metabolism and the prevention or induction of diseases. Besides, we also discussed the current methods used in the safety evaluation of Bacteroides species and key opinions about the concerns of these strains for the future use.
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Affiliation(s)
- Chen Wang
- State Key Laboratory of Food Science and Technology, Jiangnan University, Wuxi, P.R. China.,School of Food Science and Technology, Jiangnan University, Wuxi, China
| | - Jianxin Zhao
- State Key Laboratory of Food Science and Technology, Jiangnan University, Wuxi, P.R. China.,School of Food Science and Technology, Jiangnan University, Wuxi, China
| | - Hao Zhang
- State Key Laboratory of Food Science and Technology, Jiangnan University, Wuxi, P.R. China.,School of Food Science and Technology, Jiangnan University, Wuxi, China.,National Engineering Research Center for Functional Food, Jiangnan University, Wuxi, China.,Research Institute, Wuxi Translational Medicine Research Center and Jiangsu Translational Medicine, Wuxi, China.,(Yangzhou) Institute of Food Biotechnology, Jiangnan University, Yangzhou, China
| | - Yuan-Kun Lee
- Department of Microbiology & Immunology, National University of Singapore, Singapore, Singapore
| | - Qixiao Zhai
- State Key Laboratory of Food Science and Technology, Jiangnan University, Wuxi, P.R. China.,School of Food Science and Technology, Jiangnan University, Wuxi, China.,International Joint Research Laboratory for Probiotics, Jiangnan University, Wuxi, China
| | - Wei Chen
- State Key Laboratory of Food Science and Technology, Jiangnan University, Wuxi, P.R. China.,School of Food Science and Technology, Jiangnan University, Wuxi, China.,National Engineering Research Center for Functional Food, Jiangnan University, Wuxi, China.,Beijing Innovation Centre of Food Nutrition and Human Health, Beijing Technology and Business University (BTBU), Beijing, P.R. China
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26
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Zhu C, Zhao J, Huang B, Yuan D, Yang Y, Wang T. Long-term outcome of endovascular aortic repair for mycotic abdominal aortic aneurysm. ANZ J Surg 2020; 90:1376-1380. [PMID: 32648327 DOI: 10.1111/ans.16122] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2019] [Revised: 05/20/2020] [Accepted: 06/12/2020] [Indexed: 02/05/2023]
Abstract
BACKGROUND This study aimed to evaluate the feasibility and efficacy of endovascular treatment for mycotic abdominal aortic aneurysm (AAA) with long-term follow-up time period. METHODS Patients with mycotic AAA treated with endovascular aortic repair between January 2009 and December 2017 were included in this study. The preoperative and long-term outcomes during follow-up were reviewed and analysed. RESULTS Sixteen patients (12 males and four females with a mean age of 57.6 ± 14.1 years) were included in this study. The technical success rate was 100%. There were no preoperative mortalities, and one instance of deep venous thrombosis during hospitalization was recorded. The median follow-up time period was 41.2 (interquartile range 24.8-69.7) months, and the late mortality rate was 12.5%. Three (18.8%) patients presented with reinfection during follow-up. One patient presented with abdominal abscess and recurrent juxtarenal aortic aneurysm at 40 months post-operatively, and he received hybrid surgery and abdominal debridement and drainage. One patient developed staphylococcal bloodstream sepsis at 3 months post-operatively and the other patient developed Salmonella bloodstream sepsis at 9 months post-operatively. Pathogenic bacteria were consistent with the previous results. They both recovered after 2 months of intravenous antibiotic treatment. At present, all three patients are still alive without endograft infection and receiving outpatient follow-up. The aneurysm diameter decreased by more than 5 mm among five patients and remained stable in 10 patients at 1 year post-operatively. CONCLUSION Endovascular aortic repair is a feasible and effective method of treating mycotic AAA with an acceptable reinfection rate from our single-centre experience.
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Affiliation(s)
- Chenmou Zhu
- West China Medical School, Sichuan University, Chengdu, China
| | - Jichun Zhao
- Vascular Surgery Department of West China Hospital, Sichuan University, Chengdu, China
| | - Bin Huang
- Vascular Surgery Department of West China Hospital, Sichuan University, Chengdu, China
| | - Ding Yuan
- Vascular Surgery Department of West China Hospital, Sichuan University, Chengdu, China
| | - Yi Yang
- Vascular Surgery Department of West China Hospital, Sichuan University, Chengdu, China
| | - Tiehao Wang
- Vascular Surgery Department of West China Hospital, Sichuan University, Chengdu, China
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27
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García-Fernández-Bravo I, González-Munera A, Ordieres-Ortega L, Ruiz Chiriboga D, González-Leyte M. Thrombosis of an infrarenal aortic aneurysm secondary to Salmonella enteritidis infection. REVISTA DE GASTROENTEROLOGÍA DE MÉXICO (ENGLISH EDITION) 2019. [DOI: 10.1016/j.rgmxen.2018.12.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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28
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García-Fernández-Bravo I, González-Munera A, Ordieres-Ortega L, Ruiz Chiriboga D, González-Leyte M. Thrombosis of an infrarenal aortic aneurysm secondary to Salmonella enteritidis infection. REVISTA DE GASTROENTEROLOGIA DE MEXICO (ENGLISH) 2019; 84:522-524. [PMID: 31122795 DOI: 10.1016/j.rgmx.2018.12.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/09/2018] [Revised: 11/12/2018] [Accepted: 12/03/2018] [Indexed: 06/09/2023]
Affiliation(s)
| | - A González-Munera
- Servicio de Medicina Interna, Hospital General Universitario Gregorio Marañón, Madrid, España
| | - L Ordieres-Ortega
- Servicio de Medicina Interna, Hospital General Universitario Gregorio Marañón, Madrid, España
| | - D Ruiz Chiriboga
- Servicio de Angiología y Cirugía Vascular, Hospital General Universitario Gregorio Marañón, Madrid, España
| | - M González-Leyte
- Unidad de Radiología Vascular, Servicio de Radiodiagnóstico, Hospital General Universitario Gregorio Marañón, Madrid, España
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29
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Abstract
Mycotic (infected) aneurysm involving the thoracic aorta is an exceedingly rare and life-threatening condition that is associated with high morbidity and mortality. We report an unusual source of Proteus mirabilis bacteraemia thought to be due to an infected aneurysm in the thoracic aortic arch in an elderly woman. Source of gram-negative bacteraemia is usually isolated to an intra-abdominal or a pelvic source. Proteus bacteraemia from an intrathoracic pathology is very uncommon, and in this case led to a delay in diagnosis. Although an infected aneurysm is a rare source of gram-negative bacteraemia, it must always be considered when common causes of bacteraemia have been ruled out especially in patients with vascular risk factors.
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Affiliation(s)
- Sureshkumar Nagiah
- Department of General Medicine, Flinders Medical Centre, Bedford Park, South Australia, Australia
| | - Rassam Badbess
- Department of General Medicine, Flinders Medical Centre, Bedford Park, South Australia, Australia
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30
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Han Y, Kwon TW, Park SJ, Jeong MJ, Choi K, Ko GY, Lee SO, Cho YP. The Results of In Situ Prosthetic Graft Replacement for Infected Aortic Disease. World J Surg 2018; 42:3035-3041. [PMID: 29411065 DOI: 10.1007/s00268-018-4533-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Infected aortic disease is a serious clinical condition associated with significant morbidity and mortality. This study reviewed the outcomes of in situ aortic replacement with a prosthetic graft for infected aortic disease, including primary infected abdominal aortic aneurysms (PIAAA), infected aortic prosthetic grafts (IAPG), and infected aortic stent grafts (IASG). METHODS Twenty-eight consecutive patients who underwent in situ aortic replacement with a prosthetic graft for PIAAA, IAPG, and IASG at a single center from January 2001 to December 2015 were retrospectively analyzed. Demographics, clinical characteristics, medical management, surgical procedure, and clinical outcomes were included. RESULTS Nineteen patients with a PIAAA, three with an IAPG following open repair of abdominal aortic aneurysm (AAA), and six with an IASG following endovascular aortic repair underwent in situ prosthetic graft replacement with infected tissue and graft removal. In-hospital mortality was 7.1% (2/28). One died of bleeding on postoperative day 12, and the other died of hepatic failure on postoperative day 32. Of six patients with an IASG, two had major complications that were related to barb injury at the proximal aorta. The reinfection rate was 14.3% (4 of 28) during a mean follow-up of 35.7 months (1-142 months). All new grafts of three patients with IAPG were reinfected. The other patient became reinfected after surgery for PIAAA with iatrogenic small bowel perforation that was not detected during surgery. CONCLUSIONS In situ graft replacement of PIAAA and IASG is feasible with acceptable outcomes, but the outcome for IAPG is questionable.
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Affiliation(s)
- Youngjin Han
- Division of Vascular Surgery, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Republic of Korea
| | - Tae-Won Kwon
- Division of Vascular Surgery, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Republic of Korea.
| | - Sang Jun Park
- Department of Surgery, University of Ulsan College of Medicine, 877 Bangeojin Sunhwando-ro, Dong-gu, Ulsan, 44033, Republic of Korea
| | - Min-Jae Jeong
- Division of Vascular Surgery, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Republic of Korea
| | - Kyunghak Choi
- Division of Vascular Surgery, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Republic of Korea
| | - Gi-Young Ko
- Department of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Republic of Korea
| | - Sang-Oh Lee
- Department of Infectious Diseases, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Republic of Korea
| | - Yong-Pil Cho
- Division of Vascular Surgery, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Republic of Korea
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31
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Pavliňák V, Vařejka P, Lubanda JC. Infectious aneurysm of the ascending aorta - Successful conservative treatment in a high-risk patient. COR ET VASA 2018. [DOI: 10.1016/j.crvasa.2017.12.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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32
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Meng C, Guo Z, Li D, Li H, Zhou J, Wen D, Luo B. miR-183 and miR-141 in lesion tissues are potential risk factors for poor prognosis in patients with infected abdominal aortic aneurysm. Exp Ther Med 2018; 16:4695-4699. [PMID: 30542422 PMCID: PMC6257808 DOI: 10.3892/etm.2018.6733] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2017] [Accepted: 09/04/2018] [Indexed: 12/25/2022] Open
Abstract
The expression levels of micro ribonucleic acid-183 (miR-183) and miR-141 in the lesion tissues of infected abdominal aortic aneurysm (IAAA) and their relationship with prognosis were investigated. Thirty-six patients with IAAA admitted and who underwent vascular surgery in People's Hospital of Shenzhen from June 2003 to June 2013 were selected. Reverse transcription polymerase chain reaction (RT-PCR) was utilized to detect the expression levels of miR-183 and miR-141 in lesion tissues and adjacent tissues 1 cm away from the aneurysm in 36 patients with IAAA. The relationship between the expression levels of miR-183 and miR-141 as well as the clinicopathological features of patients with IAAA were analyzed, and the factors influencing the prognosis of IAAA were analyzed by univariate and multiva-riate analysis. The expression levels of miR-183 and miR-141 were significantly downregulated in the lesions of patients with IAAA, and miR-183 and miR-141 levels in the lesion tissues of the IAAA patients were significantly lower than those in the adjacent tissues (P<0.05). The expression levels of miR-183 and miR-141 were not related to sex, age, history of hypertension, and alcoholism (P>0.05), but they were related to smoking history or aneurysm size (P<0.05). The overall survival rate of patients with IAAA was 41.6% (15/36). The multivariate analysis found that aneurysm size, low expression of miR-183, and low expression of miR-141 were independent factors affecting the prognosis of patients with IAAA. In conclusion, the expression levels of miR-183 and miR-141 in the lesion tissues of IAAA are low, and the lower the expression level is, the worse the prognosis gets. miR-183 and miR-141 can be used as predictors of prognosis in patients with IAAA.
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Affiliation(s)
- Chunying Meng
- Department of Cardiovascular Surgery, Jinan University 2nd Clinical Medicine College People's Hospital of Shenzhen, Shenzhen, Guangdong 518020, P.R. China
| | - Zeheng Guo
- Out-patient Department, Futian District Maternal and Child Health Hospital of Shenzhen City, Shenzhen, Guangdong 518045, P.R. China
| | - Dagang Li
- Department of Cardiovascular Surgery, Jinan University 2nd Clinical Medicine College People's Hospital of Shenzhen, Shenzhen, Guangdong 518020, P.R. China
| | - Hanwei Li
- Department of Cardiovascular Surgery, Jinan University 2nd Clinical Medicine College People's Hospital of Shenzhen, Shenzhen, Guangdong 518020, P.R. China
| | - Jun Zhou
- Department of Cardiovascular Surgery, Jinan University 2nd Clinical Medicine College People's Hospital of Shenzhen, Shenzhen, Guangdong 518020, P.R. China
| | - Dingguo Wen
- Department of Cardiovascular Surgery, Jinan University 2nd Clinical Medicine College People's Hospital of Shenzhen, Shenzhen, Guangdong 518020, P.R. China
| | - Bin Luo
- Department of Cardiovascular Surgery, Jinan University 2nd Clinical Medicine College People's Hospital of Shenzhen, Shenzhen, Guangdong 518020, P.R. China
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33
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Deipolyi AR, Czaplicki CD, Oklu R. Inflammatory and infectious aortic diseases. Cardiovasc Diagn Ther 2018; 8:S61-S70. [PMID: 29850419 PMCID: PMC5949581 DOI: 10.21037/cdt.2017.09.03] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2017] [Accepted: 09/01/2017] [Indexed: 12/15/2022]
Abstract
Aortitis is aortic inflammation, which can be due to inflammatory or infectious diseases. Left undiagnosed, aortitis can lead to aneurysm formation and rupture, in addition to ischemic compromise of major organs. Infectious aortic diseases include mycotic aneurysm and graft infection; the most common inflammatory diseases are Takayasu's and giant cell arteritis. We review the epidemiology, etiology, presentation and diagnosis, and treatment of these entities.
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Affiliation(s)
- Amy R. Deipolyi
- Interventional Radiology Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | | | - Rahmi Oklu
- Division of Vascular & Interventional Radiology, Mayo Clinic, Phoenix, AZ, USA
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Qi YF, Xiao ZX, Shu C, Yue J, Liu SH, Chen H, Zeng ZF, Zhang WB. Infected Abdominal Aortic Aneurysms Treated with Extra-anatomic Prosthesis Bypass in the Retroperitoneum. Ann Vasc Surg 2017; 45:231-238. [PMID: 28687504 DOI: 10.1016/j.avsg.2017.06.125] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2016] [Revised: 03/15/2017] [Accepted: 06/25/2017] [Indexed: 11/27/2022]
Abstract
BACKGROUND Infected abdominal aortic aneurysms (iAAAs) are rare but life-threatening diseases. The purpose of the present study was to report our experience of extra-anatomic prosthesis bypass in the retroperitoneum as a treatment for iAAAs. METHODS Data of 8 consecutive patients diagnosed with iAAAs and treated by an extra-anatomic prosthesis bypass in the retroperitoneum were retrospectively collected. Operative details were as follows: one side of the retroperitoneal space was selected to build a track, and a bifurcated expanded polytetrafluoroethylene prosthesis was placed through the track. The proximal end of the prosthesis was sutured with the normal segment of abdominal aorta proximal to the infected aneurysm by end-to-end anostomosis. The 2 distal ends of the prosthesis were, respectively, sutured with the external iliac artery distal to the aneurysm. The anastomoses were then consolidated with the nearby connective tissue. After the closure of the retroperitoneum, the infected aneurysm was incised, and the infected tissue was debrided. Drainage tubes were placed in the aneurysm sac, which was packed with an omentum flap. All patients received perioperative antibiotic therapy for a period of time. All 8 patients were regularly followed up by outpatient observation. RESULTS Eight patients with iAAAs underwent an extra-anatomic prosthesis bypass in the retroperitoneum and debridement of the infected aneurysm. An emergency operation was performed for 1 patient who underwent concomitant gastrointestinal procedures for aortoduodenal fistula. All 8 patients were definitively diagnosed by one or more sequential computed tomography scans combined with other methods. The blood or tissue cultures of all cases were positive in the perioperative period, with Salmonella (5 cases) being the most common pathogens. Other pathogens included Burkholderia pseudomallei (2 cases) and Escherichia coli (1 case). All patients survived and were discharged in 4-5 weeks after their operations. All patients were free from graft infection during the follow-up period. CONCLUSIONS The extra-anatomic prosthesis bypass in the retroperitoneum for treating iAAAs was safe and effective. Our experience with the procedure may provide a new approach for the treatment of this disease.
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Affiliation(s)
- You-Fei Qi
- Department of Vascular Surgery, The Second Xiang-ya Hospital, Central South University, Changsha, China; Department of Vascular Surgery, Hainan General Hospital, Haikou, China
| | - Zhan-Xiang Xiao
- Department of Vascular Surgery, Hainan General Hospital, Haikou, China.
| | - Chang Shu
- Department of Vascular Surgery, The Second Xiang-ya Hospital, Central South University, Changsha, China; Department of Vascular Surgery, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Beijing, China
| | - Jie Yue
- Department of Vascular Surgery, Hainan General Hospital, Haikou, China
| | - Sa-Hua Liu
- Department of Vascular Surgery, Hainan General Hospital, Haikou, China
| | - Hao Chen
- Department of Vascular Surgery, Hainan General Hospital, Haikou, China
| | - Zhao-Fan Zeng
- Department of Vascular Surgery, Hainan General Hospital, Haikou, China
| | - Wen-Bo Zhang
- Department of Vascular Surgery, Hainan General Hospital, Haikou, China
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Strosberg DS, Oriowo BA, Davies MG, El Sayed HF. The Role of Endovascular In Situ Revascularization in the Treatment of Arterial and Graft Infections. Ann Vasc Surg 2017; 42:299.e15-299.e20. [DOI: 10.1016/j.avsg.2016.10.044] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2016] [Revised: 10/25/2016] [Accepted: 10/26/2016] [Indexed: 11/17/2022]
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Beshish AG, Arutyunyan T. Surgical Repair of Axillary Artery Aneurysm in a 2-Year-Old Child: A Case Report. Ann Vasc Surg 2017; 41:279.e1-279.e3. [PMID: 28254547 DOI: 10.1016/j.avsg.2016.09.030] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2016] [Revised: 08/31/2016] [Accepted: 09/02/2016] [Indexed: 11/28/2022]
Abstract
Peripheral aneurysm and pseudoaneurysm of an artery is a well-recognized but rare phenomenon in children. We report a case of an axillary artery aneurysm in a 2-year-old boy with methicillin-resistant Staphylococcus aureus septic shock, acute respiratory distress syndrome, and multiorgan dysfunction syndrome. Definitive surgical treatment with left axillary artery aneurysm exclusion and bypass with greater saphenous vein graft were performed. To our knowledge, this is the only axillary artery aneurysm ever reported in a child.
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Affiliation(s)
- Asaad G Beshish
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, University of Michigan, C.S. Mott Children's Hospital, Ann Arbor, MI.
| | - Tsovinar Arutyunyan
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, University of Michigan, C.S. Mott Children's Hospital, Ann Arbor, MI
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Dimitrief M, Cherbanyk F, Déglise S, Pezzetta E. Contained rupture of a mycotic infrarenal aortic aneurysm infected with Campylobacter fetus. BMJ Case Rep 2016; 2016:bcr-2016-215582. [PMID: 27852656 PMCID: PMC5128960 DOI: 10.1136/bcr-2016-215582] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Mycotic abdominal aortic aneurysms (MAAAs) are rare entities accounting for 0.65-2% of aortic aneurysms. Campylobacter fetus has a tropism for vascular tissue and is a rare cause of mycotic aneurysm. We present a 73-year-old male patient with contained rupture of a MAAA caused by C. fetus, successfully treated with endovascular aortic repair (EVAR) and antibiotics, which is not previously described for this aetiology. Although open surgery is the gold standard, EVAR is nowadays feasible and potentially represents a durable option, especially in frail patients.
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Affiliation(s)
- Maria Dimitrief
- Department of General Surgery, Hopital Riviera-Chablais, Montreux, VD, Switzerland
| | - Floryn Cherbanyk
- Department of General Surgery, Hopital Riviera-Chablais, Montreux, VD, Switzerland
| | - Sébastien Déglise
- Department of Vascular Surgery, Centre Hospitalier Universitaire Vaudois, Lausanne, VD, Switzerland
| | - Edgardo Pezzetta
- Department of General Surgery, Hopital Riviera-Chablais, Montreux, VD, Switzerland
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38
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Sasahashi N, Hamazaki M, Asada H, Kataoka T, Hamanaka K, Nishiyama K. Infected iliac artery aneurysm with aortocaval fistula. Acute Med Surg 2016; 3:400-403. [PMID: 29123822 DOI: 10.1002/ams2.202] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2015] [Accepted: 03/03/2016] [Indexed: 11/12/2022] Open
Abstract
Case We report a case of an infected iliac artery aneurysm complicated by an aortocaval fistula. Outcome A 74-year-old-man was admitted with fever, chills, general fatigue, and appetite loss. The patient was diagnosed with an infected iliac artery aneurysm, which was controlled with antibiotics preoperatively. During hospitalization, deep vein thrombosis developed with a pulmonary embolism resulting from an aortocaval fistula. The patient was successfully operated on with in situ autologous vein graft reconstruction. Conclusion An infected iliac artery aneurysm with aortocaval shunt has rarely been reported. We successfully treated the patient with a combination of appropriate i.v. antibiotics and surgical resection.
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Affiliation(s)
- Nozomu Sasahashi
- Department of Emergency and Critical Care Medicine National Hospital Organization Kyoto Medical Center Kyoto Japan
| | - Mikihisa Hamazaki
- Department of Emergency and Critical Care Medicine National Hospital Organization Kyoto Medical Center Kyoto Japan
| | - Hidenori Asada
- Department of Cardiovascular Surgery National Hospital Organization Kyoto Medical Center Kyoto Japan
| | - Tsuyoshi Kataoka
- Department of Cardiovascular Surgery National Hospital Organization Kyoto Medical Center Kyoto Japan
| | - Kunio Hamanaka
- Department of Radiology National Hospital Organization Kyoto Medical Center Kyoto Japan
| | - Kei Nishiyama
- Department of Emergency and Critical Care Medicine National Hospital Organization Kyoto Medical Center Kyoto Japan
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39
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Deipolyi AR, Rho J, Khademhosseini A, Oklu R. Diagnosis and management of mycotic aneurysms. Clin Imaging 2016; 40:256-62. [DOI: 10.1016/j.clinimag.2015.11.011] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2015] [Revised: 11/04/2015] [Accepted: 11/23/2015] [Indexed: 02/06/2023]
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40
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Fukuchi T, Kawasaki S, Hayashi H, Koreeda D, Ashikawa T. Mycotic Aneurysm Caused by Bacteroides fragilis in an Elderly Immunosuppressed Patient. Intern Med 2016; 55:3535-3538. [PMID: 27904124 PMCID: PMC5216158 DOI: 10.2169/internalmedicine.55.7090] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
An 82-year-old Japanese man, who presented with a fever and abdominal pain, was admitted to our hospital. According to enhanced computed tomography images, the probable diagnosis was abdominal aortic mycotic aneurysm. Eight sets of blood cultures obtained from the patient were negative. Despite administering treatment with vancomycin and ceftriaxone, the aneurysm progressively enlarged. He underwent open debridement surgery and in situ replacement because of an aneurysmal rupture. Bacteroides fragilis was isolated from the tissue culture of the aortic wall. Metronidazole was administered and discontinued without any infection relapse. When faced with similar cases, rare pathogens should thus be considered as possible causes of mycotic aneurysms.
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Affiliation(s)
- Takahiko Fukuchi
- Division of Internal Medicine, National Hospital Organization Minami-Wakayama Medical Center, Japan
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41
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Unosawa S, Niino T. An Infected Abdominal Aortic Aneurysm Caused by Helicobacter cinaedi. Ann Vasc Dis 2015; 8:318-20. [PMID: 26730258 DOI: 10.3400/avd.cr.15-00050] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2015] [Accepted: 08/29/2015] [Indexed: 11/13/2022] Open
Abstract
We present a rare case of an infected abdominal aortic aneurysm due to Helicobacter cinaedi that was detected by blood culture. A 79-year-old man with lumbago and left lower quadrant pain was admitted for the treatment of an infected abdominal aortic aneurysm. H. cinaedi was isolated from a blood culture, which was obtained on admission. The aneurysm was successfully treated with antibiotic therapy, aneurysmectomy, debridement, replacement of a bifurcated Dacron prosthesis, and omental wrapping. Our present case suggests that H. cinaedi should be considered as the causative agent of an infected aortic aneurysm.
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Affiliation(s)
- Satoshi Unosawa
- Department of Cardiovascular Surgery, National Hospital Organization Disaster Medical Center, Tokyo, Japan
| | - Tetsuya Niino
- Department of Cardiovascular Surgery, National Hospital Organization Disaster Medical Center, Tokyo, Japan
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42
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Hagiya H, Matsumoto M, Furukawa H, Murase T, Otsuka F. Mycotic abdominal aortic aneurysm caused by Campylobacter fetus: a case report and literature review. Ann Vasc Surg 2014; 28:1933.e7-1933.e14. [PMID: 25017776 DOI: 10.1016/j.avsg.2014.06.072] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2014] [Revised: 05/24/2014] [Accepted: 06/19/2014] [Indexed: 10/25/2022]
Abstract
Campylobacter spp. usually cause gastrointestinal infections, but among them, Campylobacter fetus is a well-known organism causing mycotic abdominal aortic aneurysm (MAAA), which requires proper surgical intervention and antibiotic therapy. We report a 65-year-old man who was successfully treated by an in situ operation using a rifampicin (RFP)-bonded J-Graft for C. fetus-induced MAAA. We performed a review of the English literature on MAAA caused by C. fetus and summarized the results of the cases (28 cases). All but 2 of the patients (92.9%) were men. Blood culture and arterial wall culture were positive in 63% and 73.1% of the cases, respectively. Aneurysm rupture was seen in half of the patients, and approximately half of those patients died. Among the 18 patients who underwent in situ graft replacement, only 1 patient (5.6%) died after surgery. Antibiotic therapy was performed for more than 1 month in most cases, and overall mortality rate was 25.9% (7 of 27 cases, 3 deaths before the operation and 4 deaths after surgery). Although extra-anatomic bypass has been conventionally performed after complete resection of an MAAA, the utility of in situ surgery has generally been recognized. Our review suggests that the in situ operation can be a choice also in cases of C. fetus-associated MAAA. Furthermore, our case suggested the clinical utility of a newly manufactured prosthetic graft, J-Graft, for such surgical treatment.
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Affiliation(s)
- Hideharu Hagiya
- Department of General Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan; Emergency Unit and Critical Care Center, Tsuyama Central Hospital, Okayama, Japan.
| | - Mitsuaki Matsumoto
- Department of Cardiovascular Surgery, Tsuyama Central Hospital, Okayama, Japan
| | - Hiroshi Furukawa
- Department of Cardiovascular Surgery, Tsuyama Central Hospital, Okayama, Japan
| | - Tomoko Murase
- Microbiology Division, Department of Clinical Laboratory, Tsuyama Central Hospital, Okayama, Japan
| | - Fumio Otsuka
- Department of General Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
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Hwang SY, Clarke JMF, Tang TY. An infected enlarging abdominal aortic aneurysm after acute cholecystitis. Int J Surg Case Rep 2014; 5:237-9. [PMID: 24705192 DOI: 10.1016/j.ijscr.2014.02.012] [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: 12/24/2013] [Accepted: 02/19/2014] [Indexed: 10/25/2022] Open
Abstract
INTRODUCTION An abdominal aortic aneurysm (AAA) infection is rare and can be difficult to manage, with high morbidity and mortality. We present a patient who suffered an infected AAA after undergoing a laparoscopic cholecystectomy and discuss the surgical management options. PRESENTATION OF CASE A 69-year-old male presents with a rapidly enlarging AAA 4 weeks following laparoscopic cholecystectomy. He was managed with open debridement, washout and repair of the aneurysm, but suffered ongoing sequelae of Escherichia coli sepsis. DISCUSSION The options for surgical management of infected AAA include open, endovascular and combined approaches. Recent papers report successful use of endovascular repair of infected AAAs but this is an ongoing area of research. CONCLUSION Infection of an AAA is associated with high mortality and long-term morbidity and requires optimal treatment. Surgical options include open debridement and repair, endovascular aneurysm repair (EVAR) or a combined approach.
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Affiliation(s)
- Sang Y Hwang
- Department of Vascular Surgery, Prince of Wales Hospital, Randwick, NSW, Australia; Prince of Wales Hospital Clinical School, University of New South Wales, Australia.
| | - James M F Clarke
- Department of Vascular Surgery, Norfolk and Norwich University Hospital, UK
| | - Tjun Y Tang
- Department of Vascular Surgery, Prince of Wales Hospital, Randwick, NSW, Australia; Department of Vascular Surgery, Norfolk and Norwich University Hospital, UK
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44
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Kim MG, Jeon JW, Ryu IH, Lee JJ, Kim JS, Choi JW, Cho BS, Yoon HJ. Mycotic abdominal aortic aneurysm caused by bacteroides thetaiotaomicron and acinetobacter lwoffii: the first case in Korea. Infect Chemother 2014; 46:54-8. [PMID: 24693472 PMCID: PMC3970306 DOI: 10.3947/ic.2014.46.1.54] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2013] [Revised: 09/09/2013] [Accepted: 09/10/2013] [Indexed: 11/24/2022] Open
Abstract
Mycotic aneurysms are uncommon, but are fatal without appropriate management. Previous reports have shown that anaerobes and gram-negative organisms are less common but more dangerous than other causative agents of mycotic aneurysm. We report the case of a 60-year-old man with poorly controlled diabetes mellitus and atherosclerosis in the aorta, and a 10-day of history of lower abdominal pain and fever. This man was diagnosed with an uncommon abdominal aorta mycotic aneurysm caused by Bacteroides thetaiotaomicron and Acinetobacter lwoffii. The aneurysm was successfully treated with antibiotics therapy and aorto-bi-external iliac artery bypass with debridement of the infected aortic wall. We present this case together with a review of the relevant literature.
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Affiliation(s)
- Min Gyu Kim
- Division of Infectious Diseases, Department of Internal Medicine, Eulji University Hospital, Eulji University College of Medicine, Daejeon, Korea
| | - Jae Woong Jeon
- Division of Infectious Diseases, Department of Internal Medicine, Eulji University Hospital, Eulji University College of Medicine, Daejeon, Korea
| | - Il Hwan Ryu
- Division of Infectious Diseases, Department of Internal Medicine, Eulji University Hospital, Eulji University College of Medicine, Daejeon, Korea
| | - Jae Joon Lee
- Division of Infectious Diseases, Department of Internal Medicine, Eulji University Hospital, Eulji University College of Medicine, Daejeon, Korea
| | - Joo Seok Kim
- Division of Infectious Diseases, Department of Internal Medicine, Eulji University Hospital, Eulji University College of Medicine, Daejeon, Korea
| | - Ji Wook Choi
- Division of Infectious Diseases, Department of Internal Medicine, Eulji University Hospital, Eulji University College of Medicine, Daejeon, Korea
| | - Byung-Sun Cho
- Division of Infectious Diseases, Department of Internal Medicine, Eulji University Hospital, Eulji University College of Medicine, Daejeon, Korea
| | - Hee Jung Yoon
- Division of Infectious Diseases, Department of Internal Medicine, Eulji University Hospital, Eulji University College of Medicine, Daejeon, Korea
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Gardner JB, Fruauff AM, Bhalla S, Katz DS. Computed tomography of nontraumatic thoracoabdominal aortic emergencies. Semin Roentgenol 2013; 49:143-56. [PMID: 24836490 DOI: 10.1053/j.ro.2013.10.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
| | - Alana M Fruauff
- Department of Radiology, Winthrop-University Hospital, Mineola, NY
| | - Sanjeev Bhalla
- Mallinckrodt Institute of Radiology, Washington University, St. Louis, MO
| | - Douglas S Katz
- Department of Radiology, Winthrop-University Hospital, Mineola, NY.
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46
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Peralta Moscoso MT, García López M, Vilariño Rico J. [Mycotic aneurysm of the abdominal aorta caused by Campylobacter fetus]. Cir Esp 2013; 93:413-5. [PMID: 24094929 DOI: 10.1016/j.ciresp.2013.06.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2013] [Accepted: 06/17/2013] [Indexed: 11/28/2022]
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47
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The differential diagnosis of two cases of chronic periaortitis. Case Rep Radiol 2013; 2013:282067. [PMID: 24066252 PMCID: PMC3771474 DOI: 10.1155/2013/282067] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2013] [Accepted: 07/31/2013] [Indexed: 12/24/2022] Open
Abstract
The imaging features of chronic periaortitis resemble those of infected aneurysms. Two illustrative cases of chronic periaortitis, in which the etiologies were caused by IgG4-related disease, are presented. The first case involved a 68-year-old man who presented with vague discomfort in his lower abdomen. The second case was a 42-year-old man who presented with a fever of 38°C and persistent, vague chest discomfort. Both cases demonstrated an increased amount of connective tissue around the aorta in computed tomography images and low intensity in the T2-weighed sequence and high intensity in the diffusion-weighed sequence, suggesting the presence of inflammation, in the magnetic resonance imaging. Negative blood cultures, elevated IgG4 levels, and pathological findings confirmed the diagnosis as chronic periaortitis due to IgG4-related disease. This is a newly recognized syndrome of unknown etiology, characterized by a fibroinflammatory condition, tumefactive lesions, and a dense lymphoplasmacytic infiltrate rich in IgG4-positive plasma cells. Both cases were successfully treated with corticosteroids. Infected aneurysms need to be carefully differentiated from this syndrome in view of the similar imaging features.
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67Ga SPECT/CT Aids in the Diagnosis of Occult Infected Common Iliac Artery Aneurysm. Clin Nucl Med 2013; 38:573-5. [DOI: 10.1097/rlu.0b013e318286c00c] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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49
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Treatment strategies for aortic and peripheral prosthetic graft infection. Surg Today 2013; 44:466-71. [DOI: 10.1007/s00595-013-0571-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2012] [Accepted: 01/16/2013] [Indexed: 10/27/2022]
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50
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Ranganath S, Stratton N, Narasimhan A, Midturi JK. Descending thoracic aortitis due to Haemophilus influenzae: a case report and literature review. Infection 2013; 41:855-8. [PMID: 23389816 DOI: 10.1007/s15010-013-0413-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2012] [Accepted: 01/18/2013] [Indexed: 11/28/2022]
Abstract
Aortitis due to Haemophilus influenzae especially involving the descending thoracic aorta is rarely encountered. We present a case and literature review concerning Haemophilus influenzae aortitis. This article serves to enhance the awareness of this extremely rare disease.
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Affiliation(s)
- S Ranganath
- Division of Infectious Diseases, Scott and White Memorial Hospital, The Texas A&M University Health Science Center College of Medicine, Temple, TX 76508, USA.
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