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Bakr AAE, Harding J, Mahmood A, Srinivasamurthy D. Stent graft exclusion of a mycotic profunda femoris artery pseudoaneurysm with 2-year follow-up. BMJ Case Rep 2019; 12:12/6/e229087. [PMID: 31160301 DOI: 10.1136/bcr-2018-229087] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
Mycotic pseudoaneurysms develop at sites of intimal disruption where bacterial invasion occurs. The conventional treatment involves arterial ligation, excision and debridement, followed by a bypass procedure at a later point. Recently, covered stent grafts have been used to treat mycotic arterial aneurysms either as temporary or definitive procedures. However, this is associated with a risk of stent graft infection, recurrence and rupture. There is a paucity of long-term results on the durability of such endovascular stent graft procedures in mycotic arterial pseudoaneurysms. We describe a successful endovascular covered stent repair of a mycotic profunda femoris artery pseudoaneurysm and follow-up of this repair at 2 years.
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Affiliation(s)
| | - James Harding
- Vascular Surgery, University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK
| | - Asif Mahmood
- Vascular Surgery, University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK
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2
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Guo Y, Bai Y, Yang C, Wang P, Gu L. Mycotic aneurysm due to Salmonella species: clinical experiences and review of the literature. ACTA ACUST UNITED AC 2018; 51:e6864. [PMID: 29947649 PMCID: PMC6040868 DOI: 10.1590/1414-431x20186864] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2017] [Accepted: 03/26/2018] [Indexed: 11/22/2022]
Abstract
The mortality of patients with mycotic aneurysms is high, especially in East Asia, and infection by Salmonella species is the most common. Our study aimed to improve prognosis of adult mycotic aneurysms with early diagnosis and accurate treatment. Four adult patients with mycotic aneurysm caused by Salmonella were included and analyzed by single-center retrospective analysis. Cases reported in the literature during the past 10 years were also summarized. The average age of the 4 male patients was 61.25 years, while that of the 53 cases reported in the literature was 65.13 years. Hypertension, diabetes, and atherosclerosis were common complications. Most patients presented fever and experienced pain at the corresponding position of the aneurysm. Laboratory examination found an increased number of white blood cells accompanied by an increase in inflammatory markers. Most aneurysms were found in the abdominal aorta, while the rupture of an aneurysm was the most common complication. The mortality rates were 21.43 and 7.14% after open surgery or endovascular aneurysm repair (EVAR) intervention, respectively. The recurrence rates of infection were 0 and 17.85% for both treatments, respectively. The mortality rate of mycotic aneurysm caused by Salmonella infection was high in middle-aged males with hypertension, diabetes, and atherosclerosis. The possibility of a Salmonella-infected aneurysm should be considered in these high-risk groups presenting chills, fever, chest, and back pain. Open surgery was superior to EVAR treatment in the clearance of infected foci and the reduction of postoperative recurrence. The recurrence of postoperative infection can be prevented by intravenous antibiotic therapy for 6 weeks post-surgery.
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Affiliation(s)
- Yiqun Guo
- Department of Infectious Diseases and Clinical Microbiology, Beijing Chao-yang Hospital, Capital Medical University, Beijing, China
| | - Yu Bai
- Department of Infectious Diseases and Clinical Microbiology, Beijing Chao-yang Hospital, Capital Medical University, Beijing, China
| | - Chunxia Yang
- Department of Infectious Diseases and Clinical Microbiology, Beijing Chao-yang Hospital, Capital Medical University, Beijing, China
| | - Peng Wang
- Department of Infectious Diseases and Clinical Microbiology, Beijing Chao-yang Hospital, Capital Medical University, Beijing, China
| | - Li Gu
- Department of Infectious Diseases and Clinical Microbiology, Beijing Chao-yang Hospital, Capital Medical University, Beijing, China
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3
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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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4
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Rammell J, Kansal N, Bhattacharya V. Management options in the treatment of femoral pseudoaneurysms secondary to intravenous drug abuse: A case series. Int J Surg Case Rep 2017; 36:30-33. [PMID: 28528282 PMCID: PMC5440756 DOI: 10.1016/j.ijscr.2017.04.024] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2017] [Revised: 04/26/2017] [Accepted: 04/30/2017] [Indexed: 11/16/2022] Open
Abstract
Infected femoral pseudoaneurysms are a common presentation in intravenous drug users with little consensus as to their optimum management. Excision and ligation of the femoral artery without revascularisation is the most common operative intervention. With the identification and optimisation of suitable patients, revascularisation can be performed in the emergency setting. Current endovascular approaches appear to be used only as a bridge to a future definitive revascularisation procedure. Ligation of the common femoral artery without revascularisation is both safe and effective as most patients will avoid critical ischaemia.
Introduction Infected femoral pseudoaneurysms are a common presentation in intravenous drug users with little consensus as to the optimum management of these patients. Whilst emergency revascularisation options are available, excision and ligation of the femoral artery remains the most common operative intervention but risks leaving the patient with critical ischaemia or intermittent claudication. This case series reviewed the outcomes of 4 patients who underwent excision-ligation without revascularisation of an infected femoral pseudoaneurysm at a district general hospital. Presentation Four patients (2 male, 2 female) with infected femoral pseudoaneurysms presented via the emergency room with diagnosis confirmed with contrast cross-sectional imaging. All patients underwent emergency excision and ligation of the pseudoaneurysm without revascularisation. One patient returned to theatre with critical ischaemia necessitating a hindquarter amputation. The remaining 3 patients were discharged without claudication symptoms. Conclusion With the identification of suitable patients and pre-operative optimisation, revascularisation can be performed in the emergency setting with an extra-anatomical bypass appearing to confer the best results. Currently endovascular approaches appear to be used only as a bridge to a future definitive revascularisation procedure, however, there are several case reports documenting successful outcomes when using a stent graft alongside a prolonged course of antibiotics. For the majority of patients, excision-ligation without revascularisation is both safe and effective as few are left with symptoms of limb ischaemia.
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Affiliation(s)
- James Rammell
- Department of Vascular Surgery, Queen Elizabeth Hospital, Queen Elizabeth Avenue, Gateshead, NE9 6SX, United Kingdom.
| | - Nisheeth Kansal
- Department of Vascular Surgery, Queen Elizabeth Hospital, Queen Elizabeth Avenue, Gateshead, NE9 6SX, United Kingdom
| | - Vish Bhattacharya
- Department of Vascular Surgery, Queen Elizabeth Hospital, Queen Elizabeth Avenue, Gateshead, NE9 6SX, United Kingdom
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5
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Tshomba Y, Papa M, Marone EM, Kahlberg A, Rizzo N, Chiesa R. A True Posterior Tibial Artery Aneurysm. Vasc Endovascular Surg 2016; 40:243-9. [PMID: 16703214 DOI: 10.1177/153857440604000311] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Aneurysms of infrapopliteal arteries are rare. The etiology is usually traumatic, and most aneurysms are false. The English-language literature reports only 33 cases of infrapopliteal arterial true aneurysms, of which 8 involve the posterior tibial artery. The etiology of these lesions is unclear; a fibromuscular fibrodysplasia similar to ulnar aneurysm may be hypothesized, but traumatic, atherosclerotic, inflammatory, and other pathological processes are also probably involved. The natural history seems to be related to thrombosis and distal embolism more than to rupture. Surgical indications are debated. Aneurysm repair with a complete restoration of the blood flow through the affected artery is particularly challenging owing to the small size of the vessels, and ligation may be required. We report, to the best of our knowledge, the first case of an atherosclerotic posterior tibial artery true aneurysm successfully treated with aneurysmectomy and end-to-end direct reconstruction with a documented good long-term patency. Clinical features, imaging findings, and surgical management are described; indications and treatments (open or endovascular) are discussed.
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Affiliation(s)
- Yamume Tshomba
- Department of Vascular Surgery, Vita-Salute University, Scientific Institute H. San Raffaele, Milan, Italy.
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6
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Callaert JRG, Fourneau I, Daenens K, Maleux G, Nevelsteen A. Endoprosthetic Treatment of a Mycotic Superficial Femoral Artery Aneurysm. J Endovasc Ther 2016; 10:843-5. [PMID: 14533954 DOI: 10.1177/152660280301000424] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose: To describe the successful stent-graft exclusion of a mycotic aneurysm of the superficial femoral artery. Case Report: A 78-year-old man presented with Salmonella arteritis and the formation of a mycotic false aneurysm of the superficial femoral artery. Antibiotics were administered; the aneurysm was excluded using 2 Hemobahn stent-grafts, and the surrounding hematoma was drained. One year postoperatively, there are no clinical or biochemical signs of infection. Ultrasound examination does not show any fluid around the patent stent-graft. Conclusions: Stent-graft placement might be an alternative to traditional surgery in selected cases of mycotic aneurysm.
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Affiliation(s)
- Joren R G Callaert
- Center for Vascular Diseases, University Hospital Gasthuisberg, Leuven, Belgium
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7
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Stent-graft placement with early debridement and antibiotic treatment for femoral pseudoaneurysms in intravenous drug addicts. Cardiovasc Intervent Radiol 2014; 38:565-72. [PMID: 25288174 DOI: 10.1007/s00270-014-0994-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2014] [Accepted: 08/16/2014] [Indexed: 10/24/2022]
Abstract
PURPOSE Explore the application of endovascular covered stent-graft (SG) placement in femoral pseudoaneurysms in intravenous drug addicts. MATERIALS AND METHODS We evaluated a consecutive series of pseudoaneurysm in intravenous drug addicts treated with SGs from August 2010 to December 2013. RESULTS 15 patients with 16 arterial pseudoaneurysms were enrolled in this study. All were males with a mean age of 36.9 years. Hemorrhage was the most common reason (93.8 %) for seeking medical care, and 3 of these patients were in hemorrhagic shock at admission. All patients received broad-spectrum antibiotics, and debridement and drainage were implemented after SG placement. 7 of the 13 cases which had microbiologic results showed mixed infections, while gram-negative bacteria were the major pathogens. Except for 2 patients, who were lost to follow-up, two new pseudoaneurysms formed due to delayed debridement, and one stent thrombosis occurred, none of the remaining cases had SG infection or developed claudication. CONCLUSIONS SG placement controls massive hemorrhage rapidly, gives enough time for subsequent treatment for pseudoaneurysms due to intravenous drug abuse, and reduces the incidence of postoperative claudication. With appropriate broad-spectrum antibiotics and early debridement, the incidence of SG infection is relatively low. It is an effective alternative especially as temporary bridge measure for critical patients. However, the high cost, uncertain long-term prospects, high demand for medical adherence, and the risk of using the conduits for re-puncture call for a cautious selection of patients. More evidence is required for the application of this treatment.
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8
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Leon LR, Thai J, Pacanowski JP. Gram-negative groin sepsis treated with covered stents and systemic antibiotics. Vascular 2011; 19:226-31. [DOI: 10.1258/vasc.2010.cr0255] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Prosthetic graft infections are hazardous conditions. Those due to Gram-negative bacteria are particularly serious. When Gram-negative microorganisms are present, entire graft excision is recommended, with revascularization if needed, preferably with autogenous tissues or with prosthetic grafts via non-infected planes if autogenous options are not available. We herein report the case of a diabetic man with critical limb ischemia, who after lower-extremity revascularization with a prosthetic graft, developed an early graft infection due to Gram-negative and fungal organisms, and who was successfully treated with a covered stent placed across grossly infected tissues. A discussion on the pertinent literature is also offered.
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Affiliation(s)
- Luis R Leon
- University of Arizona Health Science Center (AHSC)
- Tucson Medical Center (TMC) – Vascular Surgery Section, Tucson, AZ, USA
| | - Janice Thai
- University of Arizona Health Science Center (AHSC)
- Tucson Medical Center (TMC) – Vascular Surgery Section, Tucson, AZ, USA
| | - John P Pacanowski
- University of Arizona Health Science Center (AHSC)
- Tucson Medical Center (TMC) – Vascular Surgery Section, Tucson, AZ, USA
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9
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Ferrero E, Ferri M, Viazzo A, Gaggiano A, Berardi G, Piazza S, Cumbo P, Castagno C, Pecchio A, Nessi F. Rupture of a True Giant Aneurysm of the Posterior Tibial Artery: A Huge Size of 6 cm on Diameter. Ann Vasc Surg 2010; 24:1134.e9-13. [DOI: 10.1016/j.avsg.2010.01.016] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2009] [Revised: 01/21/2010] [Accepted: 01/29/2010] [Indexed: 11/16/2022]
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10
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Emergency endovascular treatment of early spontaneous nonaneurysmal popliteal artery rupture in a patient with Salmonella bacteremia. J Vasc Surg 2010; 52:751-7. [DOI: 10.1016/j.jvs.2010.04.031] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2010] [Revised: 04/14/2010] [Accepted: 04/14/2010] [Indexed: 11/24/2022]
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11
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Bowden DJ, Hayes PD, Sadat U, Choon See T. Mycotic pseudoaneurysm of the superficial femoral artery in a patient with Cushing disease: case report and literature review. Vascular 2009; 17:163-7. [PMID: 19476750 DOI: 10.2310/6670.2008.00060] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Mycotic pseudoaneurysms of the peripheral arteries are rare and can occur as an extension of localized infection or from systemic sepsis. In some cases, no obvious source of infection may be identified. Both endovascular and open surgical management options are available for this important condition. We report a mycotic pseudoaneurysm of the superficial femoral artery in a patient associated with systemic immunosuppression secondary to Cushing disease that was successfully managed with open surgical repair and autologous bypass grafting. This unusual case highlights the potential for serious adverse cardiovascular sequelae of Cushing disease and the need for awareness of such complications in this patient group.
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Affiliation(s)
- David J Bowden
- Department of Radiology, Cambridge Vascular Unit, Addenbrooke's Hospital, Cambridge University Teaching Hospitals NHS Foundation Trust, Cambridge, UK.
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12
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Lupattelli T, Garaci FG, Basile A, Minnella DP, Casini A, Clerissi J. Emergency stent grafting after unsuccessful surgical repair of a mycotic common femoral artery pseudoaneurysm in a drug abuser. Cardiovasc Intervent Radiol 2008; 32:347-51. [PMID: 18931876 DOI: 10.1007/s00270-008-9401-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2008] [Revised: 05/16/2008] [Accepted: 05/27/2008] [Indexed: 01/28/2023]
Abstract
Mycotic false aneurysm caused by local arterial injury from attempted intravenous injections in drug addicts remains a challenging clinical problem. The continued increase in drug abuse has resulted in an increased incidence of this problem, particularly in high-volume urban centres. In the drug-abusing population, mycotic arterial pseudoaneurysms most often occur because of missed venous injection and are typically seen in the groin, axilla, and antecubital fossa. Mycotic aneurysms may lead to life-threatening haemorrhage, limb loss, sepsis, and even death. Any soft-tissue swelling in the vicinity of a major artery in an intravenous drug abuser should be suspected of being a false aneurysm until proven otherwise and should prompt immediate referral to a vascular surgeon for investigation and management. We report a case of rupturing mycotic pseudoaneurysm of the left common femoral artery treated by surgical resection followed by vessel reconstruction with autologous material. Unfortunately, at the time of discharge a sudden leakage from the vein graft anastomosis occurred, with subsequent massive bleeding, and required emergent endovascular covered stenting. To the best of our knowledge, this is the first reported case of femoral artery bleeding in a drug abuser treated by stent graft placement.
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Affiliation(s)
- Tommaso Lupattelli
- Department of Interventional Radiology, Multimedica IRCCS, Sesto San Giovanni, Milan, Italy.
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13
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Endovascular Stenting of Peripheral Infected Aneurysms: A Temporary Measure or a Definitive Solution in High-Risk Patients. Cardiovasc Intervent Radiol 2008; 31:1228-35. [DOI: 10.1007/s00270-008-9372-y] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2007] [Revised: 04/21/2008] [Accepted: 05/08/2008] [Indexed: 10/21/2022]
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14
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Imaging appearances and endovascular management of uncommon pseudoaneurysms. Clin Radiol 2008; 63:1254-64. [PMID: 18929043 DOI: 10.1016/j.crad.2008.04.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2008] [Revised: 04/07/2008] [Accepted: 04/08/2008] [Indexed: 11/20/2022]
Abstract
Pseudoaneurysms are uncommon and their aetiology is varied. They occur in numerous anatomical locations and present with a multitude of clinical presentations sometimes life-threatening. This review describes the causes, sites, and presentations of uncommon pseudoaneurysms, as well as illustrating their diagnostic appearances and endovascular management.
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15
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Hallenbeck J, Koutsimpelas D, Pitton M, Külkens C, Lippert BM, Mann WJ. Endovascular Carotid Reconstruction in Palliative Head and Neck Cancer Patients with Threatened Carotid Blowout Presents a Beneficial Supportive Care Measure. J Palliat Med 2008; 11:784-9. [DOI: 10.1089/jpm.2008.9901] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
| | | | - Michael Pitton
- Department of Radiology, University Hospital of Mainz, Mainz, Germany
| | - Christoph Külkens
- Department of Otorhinolaryngology, University Hospital of Mainz, Mainz, Germany
| | - Burkard M. Lippert
- Department of Otorhinolaryngology, University Hospital of Mainz, Mainz, Germany
| | - Wolf J. Mann
- Department of Otorhinolaryngology, University Hospital of Mainz, Mainz, Germany
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16
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Stent-Graft Treatment of Mycotic Aneurysms: A Review of the Current Literature. J Vasc Interv Radiol 2008; 19:S51-6. [DOI: 10.1016/j.jvir.2008.02.012] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2007] [Revised: 02/17/2008] [Accepted: 02/17/2008] [Indexed: 11/22/2022] Open
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17
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Arterial Disease of the Lower Extremity. Surgery 2008. [DOI: 10.1007/978-0-387-68113-9_67] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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18
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Esposito G, Marone EM, De Dominicis D, Tshomba Y, Chiesa R. Hand and Wrist Arterial Aneurysms. Ann Vasc Surg 2006; 20:512-7. [PMID: 16625412 DOI: 10.1007/s10016-006-9045-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2005] [Revised: 10/14/2005] [Accepted: 02/27/2006] [Indexed: 10/24/2022]
Abstract
Hand and wrist aneurysms are a rare pathology, but recently the number of cases is increasing because of iatrogenic injuries such as catheter placement for endovascular procedures, invasive blood pressure monitoring, and arterial blood collection. In the period between January 1992 and January 2005, seven patients were treated at our institution for hand and wrist aneurysms. Five were true aneurysms and two were false aneurysms. All patients underwent surgery: four had aneurysmectomy and ligation of the arterial stumps and three had lesion removal, with arterial break suture in two cases and reconstruction with interposition of reversed autologous vein in the other case. In all cases, we did not have any postoperative ischemic or neurological complications. Symptoms like pain, paresthesia, and disesthesia combined with the minimal morbidity associated with repair suggest that operative repair of these aneurysms should be routinely performed.
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Affiliation(s)
- Gloria Esposito
- Department of Vascular Surgery, Vita-Salute University, Scientific Institute H. San Raffaele, Milan, Italy
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19
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Kotsis T, Lioupis C, Tzanis A, Nasiopoulou P, Goumas K, Bakoyiannis K, Andrikopoulos V. Endovascular Repair of a Bleeding Secondary Aortoenteric Fistula with Acute Leg Ischemia: a Case Report and Review of the Literature. J Vasc Interv Radiol 2006; 17:563-7. [PMID: 16567682 DOI: 10.1097/01.rvi.0000202745.36419.5a] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
The endovascular approach seems very attractive for patients with bleeding secondary aortoenteric fistulas (SAEF) and limb ischemia, particularly when there is no associated sepsis. Aortic stent-grafting can rapidly seal the aortoenteric communication and ensure limb reperfusion. In the present case, a 53-year-old man with a bleeding SAEF and acute leg ischemia underwent aortic stent-grafting. Ten months later, CT and leukocyte scan (Tc-99m) showed no evidence of graft infection and the patient remains well 18 months postoperatively. In the typical patient with a bleeding SAEF, endoluminal treatment, if feasible anatomically, should be considered as first-choice treatment whether it represents a "bridging" step or a "definite" solution.
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Affiliation(s)
- Thomas Kotsis
- Department of Vascular Surgery, The Red Cross Hospital of Athens, Greece.
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20
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Naqi SA, Khan HM, Akhtar S, Shah TA. Femoral pseudoaneurysm in drug addicts--excision without revascularization is a viable option. Eur J Vasc Endovasc Surg 2006; 31:585-7. [PMID: 16466941 DOI: 10.1016/j.ejvs.2005.12.011] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2005] [Accepted: 12/10/2005] [Indexed: 11/26/2022]
Abstract
PURPOSE To present a series of patients presenting with femoral pseudoaneurysm. RESULTS Seventeen patients who presented with a femoral pseudoaneurysm during a 1 year period were included in this study. Parenteral drug abuse was the most common aetiological factor. The femoral artery was most commonly involved at its bifurcation. Sixteen patients (94%) had excision of the pseudoaneurysm with ligation of vessel and debridement without any revascularization and one patient (6%) had reverse saphenous grafting after excision and ligation of vessels. Four amputations (23%) were performed. Three (17%) were major limb amputations, which included one above knee and two below knee amputations. Four patients (23%) developed intermittent claudication. CONCLUSION Excision of the pseudoaneurysm with ligation of vessels and wide debridement without immediate revascularization in infected pseudoaneurysms is a safe and effective treatment.
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Affiliation(s)
- S A Naqi
- Department of Surgery, Mayo Hospital, Lahore, Pakistan
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21
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Clarke MG, Thomas HG, Chester JF. MRSA-infected external iliac artery pseudoaneurysm treated with endovascular stenting. Cardiovasc Intervent Radiol 2005; 28:364-6. [PMID: 15886935 DOI: 10.1007/s00270-004-0254-7] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
A 48-year-old woman with severe juvenile-onset rheumatoid arthritis presented with a bleeding cutaneous sinus distal to her right total hip replacement scar. Methicillin resistant Staphylococcus aureus (MRSA) was isolated on culture. She had previously undergone bilateral total hip and knee replacements at aged 23 and six years later had the right knee prosthesis removed for infection, with subsequent osteomyelitis of the femoral shaft and right total hip prosthesis disruption. Peripheral arteriography was performed in view of persistent bleeding from the sinus, which revealed a 6 cm false aneurysm filling from and compressing the right external iliac artery (EIA). A PTFE-covered, balloon expandable JOSTENT was deployed in the right EIA, successfully excluding the false aneurysm and preventing further bleeding from the sinus. No graft infection was reported at 12 months. This case illustrates the potential use of endovascular stent-grafting in the treatment of an infected pseudoaneurysm.
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Affiliation(s)
- M G Clarke
- Department of Surgery, Taunton & Somerset Hospital, Musgrove Park, Taunton, TA1 5DA, UK
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22
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Sanada J, Matsui O, Arakawa F, Tawara M, Endo T, Ito H, Ushijima S, Endo M, Ikeda M, Miyazu K. Endovascular stent-grafting for infected iliac artery pseudoaneurysms. Cardiovasc Intervent Radiol 2005; 28:83-6. [PMID: 15602635 DOI: 10.1007/s00270-004-0005-9] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
We report two cases of acutely infected pseudoaneurysms of the iliac arteries, successfully treated with endovascular stent-grafting. Two patients underwent stent-graft treatment for erosive rupture of the iliac artery caused by surrounding infection. The first case is that of a 61-year-old man who had undergone Miles' operation for an advanced rectal cancer. Postoperatively, he developed intrapelvic abscess formation, from which methicillin-resistant Staphylococcus aureus was cultured, followed by rupture of the right external iliac artery. The second case is that of a 60-year-old man who had a pseudoaneurysm of the left common iliac artery, which was contiguous with a left psoas muscle abscess, from which Streptococcus agalactiae was cultured. Both patients were successfully treated with only a stent-graft and antibiotic therapy, and remained symptom-free 12 months and 10 months later. Although endovascular stent-grafting should not be considered standard therapy for infected aneurysms, our cases suggest that it can result in repair of infected aneurysms even in the uncontrolled active stage.
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Affiliation(s)
- Junichiro Sanada
- Department of Radiology, Kanazawa University School of Medicine, 13-1 Takara-machi, Kanazawa 920-8641, Japan.
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Kucher T, Brener B, Marak M, Parsonnet V. Endovascular Delivery of Vein Segments With Valves Versus Direct Anastomosis. J Endovasc Ther 2005; 12:366-70. [PMID: 15943513 DOI: 10.1583/05-1531.1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
PURPOSE To demonstrate an experimental model designed to allow placement of a vein segment containing a valve into a femoral vein without the need for anastomoses or surgical incision on the target limbs. METHODS Segments of jugular veins containing valves were harvested bilaterally from 7 female dogs weighing 30 to 40 kg. One of the vein segments was then interposed into one femoral vein, using a standard surgical end-to-end anastomosis. Another segment was loaded into a self-expanding nitinol stent, everted, and secured outside of the stent. This vein-coated stent was then deployed from the jugular approach into the opposite common femoral vein. The endpoint of the study was thrombosis of one of the veins segments or patency at 120 days. The function of the valves was tested prior to completion of the study by instilling dye under incremental pressures and recording the pressure necessary to cause reflux. Light microscopy and electron microscopy were utilized to evaluate structure of the valves at study endpoint. RESULTS Both grafts in one dog occluded during the second week after surgery. Anastomotic and vein-stented sites remained patent in the remaining 6 animals for 120 days. Retrograde phlebography demonstrated valve competency bilaterally in all cases. The reflux pressures on the stented side averaged 70 mmHg while the transplanted vein segment averaged 55 mmHg. Light microscopy and electron microscopy showed intact vein valve structure in all segments at the completion of the study. CONCLUSIONS This experimental work demonstrates that endovascular delivery of a native canine vein containing a competent valve is feasible and effective.
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Affiliation(s)
- Taras Kucher
- Department of Surgery, Newark Beth Israel Hospital, Newark, New Jersey 07112, USA.
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Thrower AJ, Bhasin N, Kessel D, Kent PJ. Endovascular Treatment of a MRSA Infected Left External Iliac Artery Pseudoaneurysm. Eur J Vasc Endovasc Surg 2004; 27:673-5. [PMID: 15121122 DOI: 10.1016/j.ejvs.2004.02.027] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/26/2004] [Indexed: 10/26/2022]
Affiliation(s)
- A J Thrower
- Department of Radiology, Leeds Teaching Hospitals NHS Trust, Leeds, UK
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25
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Callaert JRG, Fourneau I, Daenens K, Maleux G, Nevelsteen A. Endoprosthetic Treatment of a Mycotic Superficial Femoral Artery Aneurysm. J Endovasc Ther 2003. [DOI: 10.1583/1545-1550(2003)010<0843:etoams>2.0.co;2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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26
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Sidiropoulou MS, Giannopoulos TL, Gerukis T, Economou M, Megalopoulos A, Kalpakidis V, Palladas P. Extracranial internal carotid artery Salmonella mycotic aneurysm complicated by occlusion of the internal carotid artery: depiction by color Doppler sonography, CT and DSA. Neuroradiology 2003; 45:541-5. [PMID: 12879328 DOI: 10.1007/s00234-003-1061-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2003] [Accepted: 05/19/2003] [Indexed: 01/16/2023]
Abstract
Mycotic aneurysms of the extracranial carotid artery are rare. Seventy-four cases have been described in the medical literature and only eight secondary to Salmonella infection. To our knowledge, color Doppler sonography, computed tomography (CT), and digital subtraction angiography (DSA) findings relating to the diagnosis and follow-up of extracranial internal carotid artery mycotic aneurysm complicated by occlusion have not previously been described in the literature. We present a report of color Doppler sonography, CT, and DSA findings of a mycotic aneurysm of the right extracranial internal carotid artery due to Salmonella associated with occlusion of the internal carotid artery, promptly diagnosed and followed up using these imaging modalities.
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Affiliation(s)
- Maria S Sidiropoulou
- Department of Ultrasonography and Computed Tomography, General Peripheral Hospital G.Papanikolaou, Thessaloniki, Greece.
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27
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Sanada J, Matsui O, Terayama N, Kobayashi S, Minami T, Chujo T, Urayama H. Stent-Graft Repair of a Mycotic Left Subclavian Artery Pseudoaneurysm. J Endovasc Ther 2003. [DOI: 10.1583/1545-1550(2003)010<0066:sroaml>2.0.co;2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Sanada J, Matsui O, Terayama N, Kobayashi S, Minami T, Chujo T, Urayama H. Stent-graft repair of a mycotic left subclavian artery pseudoaneurysm. J Endovasc Ther 2003; 10:66-70. [PMID: 12751933 DOI: 10.1177/152660280301000114] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE To report successful stent-graft treatment of a mycotic pseudoaneurysm of the left subclavian artery in an immunosuppressed patient. CASE REPORT A 17-year-old immunosuppressed woman undergoing treatment for recurrent leukemia developed persistent fever and 2 episodes of hemoptysis. A contrast-enhanced computed tomographic (CT) scan demonstrated a saccular aneurysm of the left subclavian artery, which was considered to be a mycotic aneurysm caused by erosive fungal infection from the lung. The pseudoaneurysm was treated with a homemade stent-graft consisting of a nitinol stent and a polyester fabric. A type II endoleak present at the end of the procedure appeared to have sealed spontaneously on the CT scan at 3 days. No neurological deficit or ischemic symptoms of the left arm were noted during the follow-up, which lasted until the patient died 11 months later after rejecting a second bone marrow transplant. CONCLUSIONS Endovascular repair may be an alternative to open surgery for the management of mycotic aneurysms of the subclavian artery.
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Affiliation(s)
- Junichiro Sanada
- Department of Radiology, Kanazawa University School of Medicine, Japan.
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29
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Kwon K, Choi D, Choi SH, Koo BK, Ko YG, Jang Y, Shim WH, Cho SY. Percutaneous stent-graft repair of mycotic common femoral artery aneurysm. J Endovasc Ther 2002; 9:690-3. [PMID: 12431156 DOI: 10.1177/152660280200900522] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
PURPOSE To report successful percutaneous repair of a peripheral mycotic aneurysm as a bridge to standard surgical therapy. CASE REPORT An aneurysm of the left common femoral artery was diagnosed in a 43-year-old man with subacute infective endocarditis. A Jostent stent-graft was percutaneously deployed to exclude the mycotic lesion. Computed tomography at 8 months after the procedure documented aneurysm regression and stent-graft patency without evidence of infection. Arteriography at 18 months has confirmed continued stent-graft patency and the patient remains asymptomatic. CONCLUSIONS The standard management of mycotic aneurysms is usually by surgical resection and repair. However, this case suggests that percutaneous stent-graft implantation may be an option for the treatment of mycotic aneurysms.
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Affiliation(s)
- Kihwan Kwon
- Cardiology Division, Yonsei Cardiovascular Hospital and Cardiovascular Research Institute, Yonsei University College of Medicine, Seoul, Korea
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30
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Kwon K, Choi D, Choi SH, Koo BK, Ko YG, Jang Y, Shim WH, Cho SY. Percutaneous Stent-Graft Repair of Mycotic Common Femoral Artery Aneurysm. J Endovasc Ther 2002. [DOI: 10.1583/1545-1550(2002)009<0690:psgrom>2.0.co;2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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31
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Patetsios PP, Shutze W, Holden B, Garrett WV, Pearl GJ, Smith BL, Gable DR, Grimsley BR. 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; 16:521-3. [PMID: 11957003 DOI: 10.1007/s10016-001-0070-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
With the widespread use of endovascular surgery, aneurysms can be managed selectively with the use of stent grafts. Standard treatment of mycotic aneurysms usually requires resection and extraanatomic bypass. Although stent graft repair of a mycotic femoral aneurysm with autologous graft has been reported, we present a case of an infrarenal mycotic aneurysm in a patient with the human immunodeficiency virus (HIV) that was successfully treated with a novel endovascular approach.
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Affiliation(s)
- Peter P Patetsios
- Department of Surgery, Division of Vascular Surgery, Baylor University Medical Center, Dallas TX
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32
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Battaglia L, Bartolucci R, Minucci S, Biancari F, Rabitti G. Stent graft repair for rupture of the subclavian artery secondary to infection of a subclavian-to-carotid bypass graft. Ann Vasc Surg 2001; 15:474-6. [PMID: 11525539 DOI: 10.1007/s100160010123] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
The case of anastomotic rupture of the subclavian artery following infection of a subclavian-to-carotid bypass grafting is reported. Emergency endoluminal stent graft repair was life saving and aided wound healing, but stent graft thrombosis occurred. Such a complication raises some concern about the safety of this procedure in an infected setting. The use of autologous saphenous vein-covered stent graft may provide some advantages in avoiding graft infection and thrombosis.
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Affiliation(s)
- L Battaglia
- Division of Vascular Surgery, St. Camillo Hospital, Rome, Italy
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33
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Patra P, Ricco JB, Costargent A, Goueffic Y, Pillet JC, Chaillou P. Infected aneurysms of neck and limb arteries: a retrospective multicenter study. Ann Vasc Surg 2001; 15:197-205. [PMID: 11265084 DOI: 10.1007/s100160010047] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
Infected aneurysms (IA) of neck and limb arteries are uncommon. This report describes the results of a retrospective study undertaken by the University Association for Surgical Research (AURC) to evaluate etiology, bacteriology, location, diagnostic features, and therapeutic methods associated with IA. A total of 58 IA in 52 patients were reviewed. The lesion was located in a lower extremity artery in 47 patients (81%), internal carotid artery in 7 (12%), and upper extremity artery in 4 (6%). Eleven patients had multilocular aneurysm (21%). Symptoms of local infection were observed in 43 patients (82.6%). Rupture or splitting was the presenting manifestation in 13 patients (25%). Primary IA following bacteremia or septicemia without endocarditis was the most common type of IA observed in 34 patients (65.3%). Twelve patients (23%) presented mycotic IA secondary to bacterial endocarditis. In the remaining six patients (11.5%), IA resulted from direct contamination or spreading from a contiguous infection site. Surgical treatment included ligation of the artery without reconstruction in 19 patients and exclusion bypass in 33 patients. The duration of antibiotic treatment ranged from 15 days to 3 months. No recurrence of aneurysm was observed but three patients developed bypass infection. Primary IA was associated with high mortality due to severe septicemia.
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Affiliation(s)
- P Patra
- Service de Chirurgie Vasculaire, Hôpital G. et R. Laënnec, C.H.U. de Nantes, Boulevard Jacques Monod, St Herblain 44093 Nantes, France.
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34
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Arterial Disease of the Lower Extremity. Surgery 2001. [DOI: 10.1007/978-3-642-57282-1_48] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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35
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Madhavan P, McDonnell CO, Dowd MO, Sultan SA, Doyle M, Colgan MP, McEniff N, Molloy M, Moore DJ, Shanik GD. Suprarenal mycotic aneurysm exclusion using a stent with a partial autologous covering. J Endovasc Ther 2000; 7:404-9. [PMID: 11032260 DOI: 10.1177/152660280000700509] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE To report a combined endovascular and open technique to manage a suprarenal mycotic aortic aneurysm using a stent-graft partially covered with a section of autologous artery. METHODS AND RESULTS A 50-year-old was hospitalized for staphylococcal septicemia and severe back pain. A previously diagnosed 3-cm abdominal aortic aneurysm was found to have expanded 2 cm in 3 weeks. Aortography documented some periaortic thickening and 2 mycotic aneurysms, one posterior at the level of the superior mesenteric artery and the second at the aortic bifurcation. After intensive antibiotic therapy, an endovascular approach to exclude the suprarenal mycotic aneurysm was undertaken in tandem with surgical excision of the infrarenal aneurysm. The harvested right common iliac artery was used to partially cover a Palmaz stent, which was deployed under direct vision just above the renal artery ostia so that the covered portion of the stent excluded the aneurysm. A right axillofemoral bypass with a femorofemoral bypass completed the revascularization. Postoperatively, the patient developed renal failure, ischemic colitis necessitating a left hemicolectomy, and paraplegia. Although the patient is paralyzed, the aneurysm remains excluded with patent visceral vessels at 12 months following surgery. No organisms were grown from excised aortic tissue, and no signs of recurrent infection have been seen. CONCLUSIONS Stent-graft repair may be able to lessen the invasiveness and reduce the morbidity associated with treatment of mycotic aortic aneurysms.
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Affiliation(s)
- P Madhavan
- Department of Vascular Surgery, St. James's Hospital, Dublin, Ireland.
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36
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Madhavan P, McDonnell CO, Dowd MO, Sultan SAH, Doyle M, Colgan MP, McEniff N, Molloy M, Moore DJ, Shanik GD. Suprarenal Mycotic Aneurysm Exclusion Using a Stent With a Partial Autologous Covering. J Endovasc Ther 2000. [DOI: 10.1583/1545-1550(2000)007<0404:smaeua>2.0.co;2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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37
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Macdonald S, Gan J, McKay AJ, Edwards RD. Endovascular treatment of acute carotid blow-out syndrome. J Vasc Interv Radiol 2000; 11:1184-8. [PMID: 11041476 DOI: 10.1016/s1051-0443(07)61361-x] [Citation(s) in RCA: 51] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Affiliation(s)
- S Macdonald
- Interventional Radiology Unit, Gartnavel General Hospital, Glasgow, United Kingdom.
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Lagattolla NR, Baghai M, Biswas S, Redington AE, Downie AC, Miburn HJ, Taylor PR. Tuberculous false aneurysm of the femoral artery managed by endoluminal stent graft insertion. Eur J Vasc Endovasc Surg 2000; 19:440-2. [PMID: 10801384 DOI: 10.1053/ejvs.1999.1064] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- N R Lagattolla
- Department of Vascular Surgery, Guy's Hospital, St. Thomas Street, London, SE1 9RT, United Kingdom
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39
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Papadoulas S, Skroubis G, Marangos MN, Kakkos SK, Tsolakis JA. Ruptured aneurysms of superficial femoral artery. Eur J Vasc Endovasc Surg 2000; 19:430-2. [PMID: 10801380 DOI: 10.1053/ejvs.1999.0986] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- S Papadoulas
- Department of Surgery, University Hospital of Patras, Patras, Greece
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40
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Stefanadis C, Toutouzas K, Tsiamis E, Vlachopoulos C, Kallikazaros I, Stratos C, Vavuranakis M, Toutouzas P. Stents covered by autologous venous grafts: feasibility and immediate and long-term results. Am Heart J 2000; 139:437-45. [PMID: 10689258 DOI: 10.1016/s0002-8703(00)90087-5] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
BACKGROUND Previous experimental studies with a new covered stent, the autologous venous graft-covered stent (AVGCS), have shown favorable results. The aim of this study was to evaluate the feasibility and safety of this new technique in human coronary arteries and to compare the long-term outcome with uncovered stents. METHODS AND RESULTS A venous graft was removed from an upper limb. A conventional stent then was covered by the venous graft. Fifty-eight AVGCS were implanted in 56 patients, including 16 patients with acute coronary syndromes (ACS). Additionally, in 114 patients, 138 uncovered stents were implanted, serving as a control group, including 38 patients with ACS. The procedure was successful in all patients. Stent thrombosis was observed in 3 patients in the control group and in 1 patient with an AVGCS. There was a trend for the minimal luminal diameter to be greater in the AVGCS group at follow-up (P =.07), and statistical significance was observed in patients with ACS (P <.01). The target vessel revascularization and the restenosis rates were similar between the 2 groups. In patients with ACS, the restenosis rate was less (P <.04) and there was a trend for target vessel revascularization to be less in covered stents (P =.09). The event-free survival rate at 4 years was 85% in the AVGCS group versus 81% in the control group (P = not significant); in ACS it was 94% versus 78%, respectively (P = not significant). Stents covered by thicker venous grafts were associated with improved clinical outcome. CONCLUSIONS Stents covered by autologous venous grafts may be safely prepared without complications. This technique may prove to be a useful means, especially in patients with ACS.
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Affiliation(s)
- C Stefanadis
- Department of Cardiology, Hippokration Hospital, University of Athens, Greece.
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Schellhammer F, Wahkloo AK, Nagursky H, Schumacher M. Vein graft-coated stents for endovascular occlusion of canine experimental arteriovenous fistulae. Invest Radiol 1999; 34:22-7. [PMID: 9888050 DOI: 10.1097/00004424-199901000-00004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
RATIONALE AND OBJECTIVES To evaluate different vein graft-coated stent systems in the endovascular treatment of experimental arteriovenous fistulae (AVF) in a canine model. METHODS Bilateral carotid-to-external jugular vein AVF were created. Two balloon-expandable tantalum stents (Strecker stent), two self-expanding nitinol stents (Strecker stent), and one stainless-steel stent (Wallstent) were coated with autologous vein grafts and placed using a transfemoral approach. Angiography was performed immediately after stent placement and at week 1 and 3, as well as at months 3, 6, and 9. All stents were removed and underwent histologic examination. RESULTS Occlusion of the AVF succeeded with the Wallstent and both tantalum stents. The nitinol stents were misplaced, maintaining the AVF. One undersized tantalum stent and the Wallstent were occluded after 3 weeks. One nitinol stent was occluded at 3 months, whereas the two remaining stents were patent during the whole observation period. No inflammatory tissue response was seen, and no host-versus-graft reaction was present. CONCLUSIONS Preparation and implantation of vein graft-coated stents, especially in the case of self-expanding stent systems, is cumbersome. This restricts the common use of such a coating, which shows an excellent biocompatibility. Vein graft-coated stents might be of use in infected endangered vessels.
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Affiliation(s)
- F Schellhammer
- Department of Radiology, University of Cologne, Köln, Germany
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