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Ogino H, Iida O, Akutsu K, Chiba Y, Hayashi H, Ishibashi-Ueda H, Kaji S, Kato M, Komori K, Matsuda H, Minatoya K, Morisaki H, Ohki T, Saiki Y, Shigematsu K, Shiiya N, Shimizu H, Azuma N, Higami H, Ichihashi S, Iwahashi T, Kamiya K, Katsumata T, Kawaharada N, Kinoshita Y, Matsumoto T, Miyamoto S, Morisaki T, Morota T, Nanto K, Nishibe T, Okada K, Orihashi K, Tazaki J, Toma M, Tsukube T, Uchida K, Ueda T, Usui A, Yamanaka K, Yamauchi H, Yoshioka K, Kimura T, Miyata T, Okita Y, Ono M, Ueda Y. JCS/JSCVS/JATS/JSVS 2020 Guideline on Diagnosis and Treatment of Aortic Aneurysm and Aortic Dissection. Circ J 2023; 87:1410-1621. [PMID: 37661428 DOI: 10.1253/circj.cj-22-0794] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/05/2023]
Affiliation(s)
- Hitoshi Ogino
- Department of Cardiovascular Surgery, Tokyo Medical University
| | - Osamu Iida
- Cardiovascular Center, Kansai Rosai Hospital
| | - Koichi Akutsu
- Cardiovascular Medicine, Nippon Medical School Hospital
| | - Yoshiro Chiba
- Department of Cardiology, Mito Saiseikai General Hospital
| | | | | | - Shuichiro Kaji
- Department of Cardiovascular Medicine, Kansai Electric Power Hospital
| | - Masaaki Kato
- Department of Cardiovascular Surgery, Morinomiya Hospital
| | - Kimihiro Komori
- Division of Vascular and Endovascular Surgery, Department of Surgery, Nagoya University Graduate School of Medicine
| | - Hitoshi Matsuda
- Department of Cardiovascular Surgery, National Cerebral and Cardiovascular Center
| | - Kenji Minatoya
- Department of Cardiovascular Surgery, Graduate School of Medicine, Kyoto University
| | | | - Takao Ohki
- Division of Vascular Surgery, Department of Surgery, The Jikei University School of Medicine
| | - Yoshikatsu Saiki
- Division of Cardiovascular Surgery, Graduate School of Medicine, Tohoku University
| | - Kunihiro Shigematsu
- Department of Vascular Surgery, International University of Health and Welfare Mita Hospital
| | - Norihiko Shiiya
- First Department of Surgery, Hamamatsu University School of Medicine
| | | | - Nobuyoshi Azuma
- Department of Vascular Surgery, Asahikawa Medical University
| | - Hirooki Higami
- Department of Cardiology, Japanese Red Cross Otsu Hospital
| | | | - Toru Iwahashi
- Department of Cardiovascular Surgery, Tokyo Medical University
| | - Kentaro Kamiya
- Department of Cardiovascular Surgery, Tokyo Medical University
| | - Takahiro Katsumata
- Department of Thoracic and Cardiovascular Surgery, Osaka Medical College
| | - Nobuyoshi Kawaharada
- Department of Cardiovascular Surgery, Sapporo Medical University School of Medicine
| | | | - Takuya Matsumoto
- Department of Vascular Surgery, International University of Health and Welfare
| | | | - Takayuki Morisaki
- Department of General Medicine, IMSUT Hospital, the Institute of Medical Science, the University of Tokyo
| | - Tetsuro Morota
- Department of Cardiovascular Surgery, Nippon Medical School Hospital
| | | | - Toshiya Nishibe
- Department of Cardiovascular Surgery, Tokyo Medical University
| | - Kenji Okada
- Department of Surgery, Division of Cardiovascular Surgery, Kobe University Graduate School of Medicine
| | | | - Junichi Tazaki
- Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University
| | - Masanao Toma
- Department of Cardiology, Hyogo Prefectural Amagasaki General Medical Center
| | - Takuro Tsukube
- Department of Cardiovascular Surgery, Japanese Red Cross Kobe Hospital
| | - Keiji Uchida
- Cardiovascular Center, Yokohama City University Medical Center
| | - Tatsuo Ueda
- Department of Radiology, Nippon Medical School
| | - Akihiko Usui
- Department of Cardiac Surgery, Nagoya University Graduate School of Medicine
| | - Kazuo Yamanaka
- Cardiovascular Center, Nara Prefecture General Medical Center
| | - Haruo Yamauchi
- Department of Cardiac Surgery, The University of Tokyo Hospital
| | | | - Takeshi Kimura
- Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University
| | | | - Yutaka Okita
- Department of Surgery, Division of Cardiovascular Surgery, Kobe University Graduate School of Medicine
| | - Minoru Ono
- Department of Cardiac Surgery, Graduate School of Medicine, The University of Tokyo
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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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3
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Anastasiadou C, Trellopoulos G, Kastora S, Kakisis I, Papapetrou A, Galyfos G, Geroulakos G, Megalopoulos A. A systematic review of therapies for aortobronchial fistulae. J Vasc Surg 2021; 75:753-761.e3. [PMID: 34624495 DOI: 10.1016/j.jvs.2021.08.108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2020] [Accepted: 08/22/2021] [Indexed: 11/28/2022]
Abstract
OBJECTIVE The aim of the study was to summarize epidemiologic data about aortobronchial fistulas and compare outcomes (mortality, recurrence, re-operation) of open, staged, and endovascular repair of aortobronchial fistula. METHODS A systematic literature review was conducted to identify eligible studies published between January of 1999 and December of 2019. The Cochrane Library, PubMed and Scopus databases were used as search engines. Eligible studies included articles reporting postoperative outcomes (death/follow-up). Literature review revealed only case reports and small case series and thus, only descriptive data with data heterogeneity was available. The corresponding authors were contacted to provide additional information or outcome updates (recurrence/reoperation/death). RESULTS Overall, 214 patients (90 studies) underwent 271 procedures (including re-do procedures and staged procedures). Most of the patients were treated by endovascular means (72.42%). Open surgical repair was performed in 21.96% and staged procedures in 5.6%. Aortobronchial fistulae located most often in the descending thoracic aorta (Zone 3,4) (64,6%) and in Zone 2 (23,8%). Fourteen percent of aortobronchial fistulae developed after thoracic endovascular aneurysm repair. Recurrence or infection occurred in 20% (43 patients). Recurrences were at some extend associated with the presence of endoleak. Long-term antibiotic administration (>1 month) was instituted in 63 patients (29.4%), whilst 90 patients (42%) did not receive antibiotics beyond hospitalization. From the remaining 61, 3 received life-long antibiotics and for 58 patients data were not available. Considering outcomes, mean follow-up was 25.1 months (0-188 months) and not significantly different among treatments. LIMITATIONS Literature review has revealed only case reports and small case series and thus, only descriptive data were available. Randomized controlled trials are not available due to the rarity of the disease which significantly decreases the power of the present study. Also, this study reflects significant data heterogeneity due to the nature of the analyzed manuscripts and would benefit from large patient cohort studies which till today have not been conducted. CONCLUSION Aortobronchial fistula is a complex disease. Endoleaks may be involved in the development and in recurrence process and they should not be disregarded. Considering major outcomes (length of follow-up), the available treating strategies are equal and thus, surgeons should feel confident to apply the treatment of their choice, taking in mind their experience, patient's age, and clinical condition.
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Affiliation(s)
| | - George Trellopoulos
- Department of Vascular Surgery - General Hospital of Thessaloniki "Georgios Papanikolaou"
| | | | - Ioannis Kakisis
- Department of Vascular Surgery -"Attikon" University Hospital, Medical School, National and Kapodistrian University of Athens
| | | | - George Galyfos
- Department of Vascular Surgery - General Hospital of Attica "KAT"
| | - George Geroulakos
- Department of Vascular Surgery -"Attikon" University Hospital, Medical School, National and Kapodistrian University of Athens
| | - Angelos Megalopoulos
- Department of Vascular Surgery - General Hospital of Thessaloniki "Georgios Papanikolaou"
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Triantafyllidis A, Paraskeva A, Boulas KA, Nathanailidou M, Chatzipourganis K, Hatzigeorgiadis A. Aorto-cutaneous fistula from an infected ascending aorta graft resulting in massive hemorrhage after a Valsalva maneuver for a heavy weight lift. Clin Case Rep 2020; 8:2289-2290. [PMID: 33235779 PMCID: PMC7669390 DOI: 10.1002/ccr3.3089] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Revised: 05/23/2020] [Accepted: 06/07/2020] [Indexed: 11/07/2022] Open
Abstract
In the setting of an infected prosthetic ascending thoracic aorta, prompt and definitive surgical treatment is mandatory to avoid catastrophic bleeding complications.
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Puppala S, Cuthbert GA, Tingerides C, Russell DA, McPherson SJ. Endovascular management of mycotic aortic aneurysms- A 20-year experience from a single UK centre. Clin Radiol 2020; 75:712.e13-712.e21. [PMID: 32616296 DOI: 10.1016/j.crad.2020.05.019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Accepted: 05/20/2020] [Indexed: 01/16/2023]
Abstract
AIM To present the authors' experience of endovascular treatment of confirmed and presumed (microbiology negative) mycotic aortic aneurysms (MAA). MATERIALS AND METHODS Patients undergoing endovascular aortic repair were identified retrospectively from 1998 using the radiology information system and an internally kept database until 2018. The primary aim was to assess the technical success and peri-operative morbidity and mortality. The secondary aim was to assess progression of infection, re-interventions, late mortality, and correlation to antibiotic duration pre- and post-procedure. RESULTS Thirty-four endovascular aortic procedures were performed for MAA, excluding aorto-enteric fistulas, inflammatory aneurysms, and infected grafts without a new aneurysm. Seventy-six percent of these were thoracic and 24% abdominal. The technical success was 100%. Additional procedures were undertaken in four patients with two requiring a further endovascular procedure. There were two inpatient aneurysm-related mortalities and no inpatient conversions to open repair. The 30-day re-admission and re-intervention rate was 0%. Blood cultures were positive in 45%. There were no secondary graft infections. CONCLUSION This is the largest European single-centre study. It supports endovascular management of MAA as a lower-risk alternative to open surgery with the majority of patients presenting acutely, later in life and requiring emergency management.
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Affiliation(s)
- S Puppala
- Vascular Interventional Radiology, Leeds Teaching Hospital NHS Trust, Leeds, UK.
| | - G A Cuthbert
- Leeds Vascular Institute, Leeds Teaching Hospital NHS Trust, Leeds, UK
| | - C Tingerides
- Vascular Interventional Radiology, Leeds Teaching Hospital NHS Trust, Leeds, UK
| | - D A Russell
- Leeds Vascular Institute, Leeds Teaching Hospital NHS Trust, Leeds, UK
| | - S J McPherson
- Vascular Interventional Radiology, Leeds Teaching Hospital NHS Trust, Leeds, UK
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6
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Response Findings after Treatment and Outcomes on CT after Endovascular Repair of Mycotic Aortic Aneurysm. J Vasc Interv Radiol 2020; 31:969-976. [PMID: 32414571 DOI: 10.1016/j.jvir.2019.12.803] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2019] [Revised: 12/12/2019] [Accepted: 12/30/2019] [Indexed: 10/24/2022] Open
Abstract
PURPOSE To demonstrate post-treatment computed tomography (CT) findings and outcomes of endovascular aortic repair (EVAR) for mycotic aortic aneurysm (MAA). MATERIALS AND METHODS Clinical data of patients with MAA who underwent EVAR from June 2010 to December 2017 were retrospectively reviewed. A total of 22 patients were included (19 men and 3 women). The periaortic features of the MAA regression after EVAR were graded and evaluated by follow-up CT. RESULTS The median follow-up was 36.5 months (range, 0.5-97 months.). The cumulative survival rate at 1 month, 6 months, 1 year, and 5 years was 95.5%, 86.4%, 81.6%, and 73.4%, respectively. The early and late infection-related complication (IRC) rate was 18.2% and 13.6%, respectively. One patient died within 1 month from severe acidosis and shock. Of the other patients, the median time to stable response of the MAA was 6 months (range, 3-36 months). Fourteen patients (66.7%) showed early response of the MAA, while 7 patients (33.3%) showed delayed response. A significant association was observed between delayed response and late IRCs (P = .026). CONCLUSIONS The post-EVAR periaortic features on follow-up CT aid in monitoring the treatment response of the MAA. Early response of the MAA was associated with a low rate of late IRCs and might aid in adjusting the antibiotic duration after the patient has achieved complete or nearly complete regression of the MAA.
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Ito K, Oguri T, Nakano A, Fukumitsu K, Fukuda S, Kanemitsu Y, Takakuwa O, Ohkubo H, Takemura M, Maeno K, Ito Y, Niimi A. Aortoesophageal Fistula Occurring during Lung Cancer Treatment: A Case Treated by Thoracic Endovascular Aortic Repair. Intern Med 2019; 58:3025-3028. [PMID: 31243231 PMCID: PMC6859395 DOI: 10.2169/internalmedicine.2331-18] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
A 63-year-old man had received chemoradiotherapy 7 years ago for stage IIIA pulmonary adenocarcinoma of the left lower lobe and stereotactic irradiation 3 years ago for stage IA pulmonary squamous cell carcinoma of the left upper lobe. An esophageal stent was placed because of esophageal narrowing caused by tumor invasion. Five months later, he was diagnosed with an aortoesophageal fistula. Because invasive surgery posed challenges, thoracic endovascular aortic repair (TEVAR) was performed. We report this rare case of aortoesophageal fistula treated using TEVAR. However, the therapeutic effect was temporary. Further studies investigating the indications for TEVAR are warranted.
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Affiliation(s)
- Keima Ito
- Department of Respiratory Medicine, Allergy and Clinical Immunology, Nagoya City University Graduate School of Medical Sciences, Japan
| | - Tetsuya Oguri
- Department of Respiratory Medicine, Allergy and Clinical Immunology, Nagoya City University Graduate School of Medical Sciences, Japan
- Department od Education and Research Center for Community Medicine, Nagoya City University Graduate School of Medical Sciences, Japan
| | - Akiko Nakano
- Department of Respiratory Medicine, Allergy and Clinical Immunology, Nagoya City University Graduate School of Medical Sciences, Japan
| | - Kensuke Fukumitsu
- Department of Respiratory Medicine, Allergy and Clinical Immunology, Nagoya City University Graduate School of Medical Sciences, Japan
| | - Satoshi Fukuda
- Department of Respiratory Medicine, Allergy and Clinical Immunology, Nagoya City University Graduate School of Medical Sciences, Japan
| | - Yoshihiro Kanemitsu
- Department of Respiratory Medicine, Allergy and Clinical Immunology, Nagoya City University Graduate School of Medical Sciences, Japan
| | - Osamu Takakuwa
- Department of Respiratory Medicine, Allergy and Clinical Immunology, Nagoya City University Graduate School of Medical Sciences, Japan
| | - Hirotsugu Ohkubo
- Department of Respiratory Medicine, Allergy and Clinical Immunology, Nagoya City University Graduate School of Medical Sciences, Japan
| | - Masaya Takemura
- Department of Respiratory Medicine, Allergy and Clinical Immunology, Nagoya City University Graduate School of Medical Sciences, Japan
| | - Ken Maeno
- Department of Respiratory Medicine, Allergy and Clinical Immunology, Nagoya City University Graduate School of Medical Sciences, Japan
| | - Yutaka Ito
- Department of Respiratory Medicine, Allergy and Clinical Immunology, Nagoya City University Graduate School of Medical Sciences, Japan
| | - Akio Niimi
- Department of Respiratory Medicine, Allergy and Clinical Immunology, Nagoya City University Graduate School of Medical Sciences, Japan
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Cullen JM, Booth AT, Mehaffey JH, Hawkins RB, Spinosa M, Cherry KJ, Robinson WP, Tracci MC, Kern JA, Upchurch GR. Clinical Characteristics and Longitudinal Outcomes of Primary Mycotic Aortic Aneurysms. Angiology 2019; 70:947-951. [PMID: 31238697 DOI: 10.1177/0003319719858784] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
Medical therapy for mycotic aortic aneurysms (MAA) is almost universally fatal, while surgical and endovascular repair carry high morbidity and mortality. The purpose of this study was to compare outcomes between patients receiving treatment for MAA. Records were obtained and patients with MAA were stratified by intervention: endovascular repair, open surgery, and medical therapy. Primary outcomes were aneurysm-related mortality and survival. Risk-adjusted associations with mortality were assessed using time-to-event analysis. Thirty-eight patients were identified (median age, 67). Twenty-one underwent endovascular repair,10 had open surgery and 7 received medical therapy alone. Overall mortality was 47% (n = 18), with 94% aneurysm related. Median survival was significantly longer in the endovascular group (747.0 [161-1249]) vs open surgery and medical therapy (507.5 [34-806] and 66 [13-146] days, respectively; P = .02). The endovascular group had significantly fewer perioperative complications (43% vs 80%, P < .01). However, 4 endovascular patients experienced reinfection versus no open surgery patients. Mortality risk factors included medical therapy (hazard ratio [HR]: 5.3, P < .01) and aneurysm size (HR: 1.4 per 1-cm increase in diameter, P = .03). Endovascular repair of MAA was associated with the best long-term survival and lowest perioperative complication rate, although it is associated with greater reinfection. These tradeoffs should be considered when selecting which procedure is best for a patient.
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Affiliation(s)
- J Michael Cullen
- 1 Department of Surgery, University of Virginia, Charlottesville, VA, USA
| | - Alexander T Booth
- 2 School of Medicine, University of Virginia, Charlottesville, VA, USA
| | - J Hunter Mehaffey
- 1 Department of Surgery, University of Virginia, Charlottesville, VA, USA
| | - Robert B Hawkins
- 1 Department of Surgery, University of Virginia, Charlottesville, VA, USA
| | - Michael Spinosa
- 1 Department of Surgery, University of Virginia, Charlottesville, VA, USA
| | - Kenneth J Cherry
- 3 Division of Thoracic and Cardiovascular Surgery, University of Virginia, Charlottesville, VA, USA
| | - William P Robinson
- 3 Division of Thoracic and Cardiovascular Surgery, University of Virginia, Charlottesville, VA, USA
| | - Margaret C Tracci
- 3 Division of Thoracic and Cardiovascular Surgery, University of Virginia, Charlottesville, VA, USA
| | - John A Kern
- 3 Division of Thoracic and Cardiovascular Surgery, University of Virginia, Charlottesville, VA, USA
| | - Gilbert R Upchurch
- 3 Division of Thoracic and Cardiovascular Surgery, University of Virginia, Charlottesville, VA, USA.,4 Department of Surgery, University of Florida, Gainesville, FL, USA
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Aoki C, Fukuda W, Kondo N, Minakawa M, Taniguchi S, Daitoku K, Fukuda I. Surgical Management of Mycotic Aortic Aneurysms. Ann Vasc Dis 2017; 10:29-35. [PMID: 29034017 PMCID: PMC5579801 DOI: 10.3400/avd.oa.16-00117] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2016] [Accepted: 01/13/2017] [Indexed: 11/21/2022] Open
Abstract
Purpose: A mycotic aneurysm is an uncommon disease associated with a high mortality rate when managed surgically. This study reviewed our experiences in the surgical management of mycotic aortic aneurysms. Methods: In total, 26 patients who underwent surgery for a mycotic aneurysm were retrospectively reviewed. The mycotic aneurysms involved the thoracic aorta in 9 patients, the thoracoabdominal aorta in 4 patients, and the abdominal aorta in 13 patients. An overt aortic rupture in the mediastinum or retroperitoneal space was detected in 4 patients. Patients were classified into one of two groups, febrile or afebrile, and background characteristics, surgical intervention, and early and late mortalities were all compared. Results: There were 19 patients who underwent open surgery, and 7 patients underwent endovascular repair. No significant differences in the clinical characteristics were found between the two groups; however, the incidence of postoperative complications was significantly higher in the febrile group than in the afebrile group (P=0.024). Overall mortality was 15.4% (4/26), and 30-day mortality was 7.7% (2/26). Conclusion: Although febrile patients had a higher incidence of postoperative complications, surgical mortality from a mycotic aneurysm was within an acceptable range. Each patient should be thoroughly evaluated and treated on a case-by-case basis, using conventional open repair, endovascular repair, or a combination of both approaches.
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Affiliation(s)
- Chikashi Aoki
- Department of Thoracic and Cardiovascular Surgery, Hiro-saki University Graduate School of Medicine, Hirosaki, Aomori, Japan
| | - Wakako Fukuda
- Department of Thoracic and Cardiovascular Surgery, Hiro-saki University Graduate School of Medicine, Hirosaki, Aomori, Japan
| | - Norihiro Kondo
- Department of Thoracic and Cardiovascular Surgery, Hiro-saki University Graduate School of Medicine, Hirosaki, Aomori, Japan
| | - Masahito Minakawa
- Department of Thoracic and Cardiovascular Surgery, Hiro-saki University Graduate School of Medicine, Hirosaki, Aomori, Japan
| | - Satoshi Taniguchi
- Department of Thoracic and Cardiovascular Surgery, Hiro-saki University Graduate School of Medicine, Hirosaki, Aomori, Japan
| | - Kazuyuki Daitoku
- Department of Thoracic and Cardiovascular Surgery, Hiro-saki University Graduate School of Medicine, Hirosaki, Aomori, Japan
| | - Ikuo Fukuda
- Department of Thoracic and Cardiovascular Surgery, Hiro-saki University Graduate School of Medicine, Hirosaki, Aomori, Japan
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Koganti D, Ryan SP, Kwon J, Abai B, Dimuzio PJ, Salvatore DM. Atypical Mycotic Aortic Aneurysms. Ann Vasc Surg 2016; 36:296.e13-296.e18. [DOI: 10.1016/j.avsg.2016.04.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2015] [Revised: 03/15/2016] [Accepted: 04/04/2016] [Indexed: 12/21/2022]
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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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Inoue H, Iguro Y, Ueno M, Yamamoto K. Extra-Anatomic Bypass Operation for an Infected Aortic Arch Aneurysm with Broad Mediastinal Abscess: A Case Report. Ann Vasc Dis 2015; 8:246-8. [PMID: 26421075 DOI: 10.3400/avd.cr.15-00009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2015] [Accepted: 05/02/2015] [Indexed: 11/13/2022] Open
Abstract
We encountered an informative case of infected aortic arch aneurysm. The proximal descending aorta, left common carotid artery, and left subclavian artery were severely involved in an abscess; thus, typical in situ reconstruction of the arch was considered impossible. Therefore, to secure more distal branches appropriate for anastomosis, a modified extra-anatomic arch repair was performed through additional incisions. The patient developed renal and respiratory failure and died of septicemia five and a half months after the operation. However, postoperative computed tomograms demonstrated that the abscess had disappeared.
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Affiliation(s)
- Hironori Inoue
- Department of Cardiovascular Surgery, Tenyoukai Central Hospital, Kagoshima, Kagoshima, Japan
| | | | - Masahiro Ueno
- Department of Cardiovascular Surgery, Tenyoukai Central Hospital, Kagoshima, Kagoshima, Japan
| | - Keisuke Yamamoto
- Department of Cardiovascular Surgery, Tenyoukai Central Hospital, Kagoshima, Kagoshima, Japan
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Hafez H, Jamjoom R, Yuones E, Khan Z, Ashour M. Endovascular repair of a mycotic thoracic aortic aneurysm in a patient with aortic coarctation. J Vasc Surg Cases 2015; 1:154-156. [PMID: 31724653 PMCID: PMC6849998 DOI: 10.1016/j.jvsc.2015.04.008] [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: 02/17/2015] [Accepted: 04/16/2015] [Indexed: 11/28/2022] Open
Abstract
This report describes the management of a 28-year-old female patient who presented with septicemia and mediastinal mass-effect secondary to a proximal mycotic aneurysm of the descending aorta. The patient had an infected bicuspid aortic valve, aortic coarctation, and a left vertebral artery arising directly from the aortic arch. Evidence of disseminated embolization affecting her posterior cerebral circulation, the left axillary, and the superior mesenteric arteries was noted. The patient had a considerably small aorta. An urgent thoracic endovascular aortic repair was performed successfully with a chimney stent to the left vertebral artery. The report discusses the planning and technique used in managing this complex case.
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Affiliation(s)
- Hany Hafez
- Department of Vascular and Endovascular Surgery, King Faisal Specialist Hospital and Research Centre, Jeddah, Saudi Arabia
| | - Reda Jamjoom
- Department of Vascular and Endovascular Surgery, King Faisal Specialist Hospital and Research Centre, Jeddah, Saudi Arabia
| | - Elsayed Yuones
- Department of Vascular and Endovascular Surgery, King Faisal Specialist Hospital and Research Centre, Jeddah, Saudi Arabia
| | - Zahid Khan
- Department of Interventional Radiology, King Faisal Specialist Hospital and Research Centre, Jeddah, Saudi Arabia
| | - Majed Ashour
- Department of Interventional Radiology, King Faisal Specialist Hospital and Research Centre, Jeddah, Saudi Arabia
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Successful Emergent Endovascular Repair of a Ruptured Mycotic Thoracic Aortic Aneurysm. Ann Vasc Surg 2015; 29:843.e1-6. [DOI: 10.1016/j.avsg.2014.12.035] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2014] [Revised: 11/18/2014] [Accepted: 12/29/2014] [Indexed: 11/17/2022]
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16
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Yamanaka K, Omura A, Nomura Y, Miyahara S, Shirasaka T, Sakamoto T, Inoue T, Matsumori M, Minami H, Okada K, Okita Y. Surgical strategy for aorta-related infection†. Eur J Cardiothorac Surg 2014; 46:974-80; discussion 980. [DOI: 10.1093/ejcts/ezu119] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Canaud L, Ozdemir BA, Bee WW, Bahia S, Holt P, Thompson M. Thoracic endovascular aortic repair in management of aortoesophageal fistulas. J Vasc Surg 2013; 59:248-54. [PMID: 24199764 DOI: 10.1016/j.jvs.2013.07.117] [Citation(s) in RCA: 74] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2013] [Revised: 07/29/2013] [Accepted: 07/29/2013] [Indexed: 12/22/2022]
Abstract
OBJECTIVE To provide a systematic review of the outcomes of thoracic endovascular aortic repair (TEVAR) for aortoesophageal fistula (AEF) and to identify prognostic factors associated with poor outcomes. METHODS Literature searches of the Embase, Medline, and Cochrane databases identified relevant articles reporting results of TEVAR for AEF. The main outcome measure was the composite of aortic mortality, recurrence of the AEF, and stent graft explantation. The secondary outcome measure was aortic-related mortality. RESULTS Fifty-five articles were integrated after a literature search identified 72 patients treated by TEVAR for AEFs. The technical success rate of TEVAR was 87.3%. The overall 30-day mortality was 19.4%. Prolonged antibiotics (>4 weeks) were administered in 80% of patients. Concomitant or staged resection or repair of the esophagus was performed in 44.4% of patients. Stent graft explantation was performed within the first month after TEVAR as a planned treatment in 11.1%. After a mean follow-up of 7.4 months (range, 1-33 months), the all-cause mortality was 40.2%, and the aortic-related mortality was 33.3. Prolonged antibiotic treatment (P = .001) and repair of AEFs due to a foreign body (P = .038) were associated with a significant lower aortic mortality. On univariate analysis, TEVAR and concomitant or staged adjunctive procedures (resection, repair of the esophagus, or a planned stent graft explantation) were associated with a significantly lower incidence of aortic-related mortality (P = .0121). When entered into a binary logistic regression analysis, prolonged antibiotic treatment was the only factor associated with a significant lower incidence of the endpoint (P = .003). CONCLUSIONS Late infection or recurrence of the AEF and associated mortality rates are high when TEVAR is used as a sole therapeutic strategy. Prolonged antibiotic treatment has a strong negative association with mortality. A strategy of a temporizing endovascular procedure to stabilize the patient in extremis, and upon recovery, an open surgical esophageal repair with or without stent graft explantation is advocated.
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Affiliation(s)
- Ludovic Canaud
- Department of Outcomes Research, St George's Vascular Institute, London, United Kingdom.
| | - Baris Ata Ozdemir
- Department of Outcomes Research, St George's Vascular Institute, London, United Kingdom
| | - William Wynter Bee
- Department of Outcomes Research, St George's Vascular Institute, London, United Kingdom
| | - Sandeep Bahia
- Department of Outcomes Research, St George's Vascular Institute, London, United Kingdom
| | - Peter Holt
- Department of Outcomes Research, St George's Vascular Institute, London, United Kingdom
| | - Matt Thompson
- Department of Outcomes Research, St George's Vascular Institute, London, United Kingdom
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Canaud L, Ozdemir BA, Bahia S, Hinchliffe R, Loftus I, Thompson M. Thoracic Endovascular Aortic Repair for Aortobronchial Fistula. Ann Thorac Surg 2013; 96:1117-21. [DOI: 10.1016/j.athoracsur.2013.04.090] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2013] [Revised: 04/12/2013] [Accepted: 04/15/2013] [Indexed: 10/26/2022]
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19
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Flis V, Matela J, Breznik S, Kobilica N. Treatment of Primary Infected Juxtarenal Aortic Aneurysm With the Multilayer Stent. Vasc Endovascular Surg 2013; 47:561-5. [DOI: 10.1177/1538574413497108] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Purpose: To report the use of multilayer uncovered stent to treat primary infected juxtarenal aortic aneurysm. Case Report: A 50-year-old man was admitted to hospital for rapid onset of intractable abdominal pain and high fever. Computed tomographic scan showed 2 juxtarenal saccular aneurysms of abdominal aorta with morphologic and clinical changes compatible with infectious etiology. Patient was treated with multilayer flow-modulating stent. Follow-up imaging showed persistent aneurysm exclusion and continuous aneurysm shrinkage of the sac until complete regression to a normal aortic configuration was seen at 1 year. During follow-up (24 months), patient continued to do well, and there was no recurrence of infection. Conclusion: Multilayer stent appeared to be an acceptable treatment option for primary infected juxtarenal aortic aneurysms. Aneurysmal sac completely disappeared and visceral branches remained patent at 2-year follow-up. However, longer follow-up is necessary to evaluate the long-term patency of involved visceral arteries.
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Affiliation(s)
- Vojko Flis
- Department of Vascular Surgery, University Medical Center Maribor, Maribor, Slovenia
| | - Jože Matela
- Department of Radiology, University Medical Center Maribor, Maribor, Slovenia
| | - Silva Breznik
- Department of Radiology, University Medical Center Maribor, Maribor, Slovenia
| | - Nina Kobilica
- Department of Vascular Surgery, University Medical Center Maribor, Maribor, Slovenia
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Jia X, Dong YF, Liu XP, Xiong J, Zhang HP, Guo W. Open and Endovascular Repair of Primary Mycotic Aortic Aneurysms: A 10-Year Single-Center Experience. J Endovasc Ther 2013; 20:305-10. [DOI: 10.1583/13-4222mr.1] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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21
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Bypass hepatorrenal y secuencial a mesentérica superior en paciente con seudoaneurisma micótico. ANGIOLOGIA 2013. [DOI: 10.1016/j.angio.2013.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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22
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Ozaki K, Sanada J, Ohtake H, Watanabe G, Matsui O. Successful thoracic endovascular aortic repair of an aortoesophageal fistula. Vascular 2013; 21:97-101. [DOI: 10.1177/1708538113478716] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
We report three cases of aortoesophageal fistula (AEF), in which the patients remained free from catastrophic bleeding after endovascular stent-grafting. The three patients, who were not candidates for surgical repair because of their poor general condition and prognosis, underwent endovascular stent-grafting following the administration of antibiotics and were successfully managed; hemostasis was maintained for several months until their death. Although we did not find any conclusive evidence to support this strategy, our experiences suggest that endovascular stent-grafting of AEF is useful for maintaining hemodynamic stability.
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Affiliation(s)
- Kumi Ozaki
- Kanazawa University Graduate School of Medical Science – Radiology
| | - Junichiro Sanada
- Kanazawa University Graduate School of Medical Science – Radiology
| | - Hiroshi Ohtake
- Kanazawa University Graduate School of Medical Science – General and Cardiothoracic Surgery, Kanazawa, Ishikawa 920-8641, Japan
| | - Go Watanabe
- Kanazawa University Graduate School of Medical Science – General and Cardiothoracic Surgery, Kanazawa, Ishikawa 920-8641, Japan
| | - Osamu Matsui
- Kanazawa University Graduate School of Medical Science – Radiology
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Dimitrakakis G, von Oppell UO, Azzu AA. eComment. Mycotic aortic aneurysms: a real challenge for the cardiac surgeon. Interact Cardiovasc Thorac Surg 2012; 16:83-4. [PMID: 23248213 DOI: 10.1093/icvts/ivs505] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Yamane K, Bogar LJ, DiMuzio PJ, Cowan SW, Hirose H, Evans NR, Rao AS, Eisenberg JA, Cavarocchi NC. Contained rupture of a pseudoaneurysm of the descending thoracic aorta related to remnant outflow graft of left ventricular assist device after heart transplantation. Ann Thorac Surg 2012; 94:1345-8. [PMID: 23006696 DOI: 10.1016/j.athoracsur.2012.02.023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2011] [Revised: 12/06/2011] [Accepted: 02/02/2012] [Indexed: 10/27/2022]
Abstract
The Jarvik 2000 left ventricular assist device is inserted via a left thoracotomy with the outflow graft anastomosed to the descending thoracic aorta. Removal of the device during heart transplantation involves division of the outflow graft, resulting in a retained remnant. We describe the first reported case of a mycotic pseudoaneurysm of the descending thoracic aorta related to the remnant of a left ventricular assist device outflow graft in an immunosuppressed heart recipient complicated with systemic Pseudomonas infection. The pseudoaneurysm was temporarily treated with endovascular stent grafting followed by delayed thoracotomy, pseudoaneurysm excision, and placement of an aortic interposition graft using an aortic allograft.
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Affiliation(s)
- Kentaro Yamane
- Division of Cardiothoracic Surgery, Department of Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania 19107, USA.
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Civilini E, Bertoglio L, Rinaldi E, Chiesa R. TEVAR for Ruptured Mycotic Aneurysm in a Patient With a Left Ventricular Assist Device. J Endovasc Ther 2012; 19:370-2. [DOI: 10.1583/12-3821r.1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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26
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Kritpracha B, Premprabha D, Sungsiri J, Tantarattanapong W, Rookkapan S, Juntarapatin P. Endovascular therapy for infected aortic aneurysms. J Vasc Surg 2011; 54:1259-65; discussion 1265. [DOI: 10.1016/j.jvs.2011.03.301] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2010] [Revised: 02/01/2011] [Accepted: 03/01/2011] [Indexed: 10/17/2022]
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27
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Vallejo N, Picardo NE, Bourke P, Bicknell C, Cheshire NJ, Jenkins MP, Wolfe J, Gibbs RG. The changing management of primary mycotic aortic aneurysms. J Vasc Surg 2011; 54:334-40. [DOI: 10.1016/j.jvs.2010.12.066] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2010] [Revised: 12/27/2010] [Accepted: 12/27/2010] [Indexed: 02/05/2023]
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28
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Thoracic aortic endovascular repair for mycotic aneurysms and fistulas. J Vasc Surg 2010; 52:37S-40S. [DOI: 10.1016/j.jvs.2010.06.139] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2010] [Revised: 06/15/2010] [Accepted: 06/17/2010] [Indexed: 11/18/2022]
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29
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Brossier J, Lesprit P, Marzelle J, Allaire E, Becquemin JP, Desgranges P. New bacteriological patterns in primary infected aorto-iliac aneurysms: a single-centre experience. Eur J Vasc Endovasc Surg 2010; 40:582-8. [PMID: 20843713 DOI: 10.1016/j.ejvs.2010.07.020] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2010] [Accepted: 07/28/2010] [Indexed: 10/19/2022]
Abstract
OBJECTIVES To assess causative pathogens and surgical outcomes in patients with primary infected aorto-iliac aneurysms at our institution. DESIGN Retrospective study of patients treated at a university hospital between 1992 and 2009. RESULTS We identified 26 patients (median age, 63 years) with primary infected aneurysms on the aorta (descending thoracic, n = 2; thoraco-abdominal, n = 3; suprarenal, n = 2; infrarenal, n = 15) or iliac arteries (n = 4). Among them, 22 were symptomatic, including 13 with ruptured aneurysms. The causative organisms, identified in 25/26 patients, were Campylobacter fetus, n = 6; Streptococcus pneumoniae, n = 4; Listeria, n = 3; Salmonella, n = 2; Mycobacterium tuberculosis, n = 2; Staphylococcus aureus, n = 1; and other, n = 7. Immune suppression was a feature in 10 (38.4%) patients. Revascularisation was performed in situ in 23 patients (10 allografts, eight grafts, three superficial femoral veins, and 2 stentgrafts) and by extra-anatomic bypass in three patients. Hospital mortality was 23% (in situ group, 17.4%; extra-anatomic group, 66.7%; χ(2)(Yates), P = 0.24). During follow-up in the 20 survivors (median, 48.5 months), there were two non-infection-related deaths (five and 24 months) and six (30%) vascular complications. CONCLUSIONS The bacteriological spectrum of primary infected aorto-iliac aneurysms was wider than previously reported. The availability of new diagnostic tests and increased prevalence of immunosuppression may explain this finding.
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Affiliation(s)
- J Brossier
- Department of Vascular Surgery, Henri Mondor Hospital, AP/HP, University Paris Val de Marne, Créteil 94000, Paris, France
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Iimori A, Kanzaki Y, Ito S, Kotani T, Hirano-Kuwata S, Daimon M, Katsumata T, Akagi H, Komori T, Terasaki F, Ishizaka N, Ukimura A. Rapidly progressing aneurysm of infected thoracic aorta with pseudoaneurysm formation. Intern Med 2010; 49:2461-5. [PMID: 21088350 DOI: 10.2169/internalmedicine.49.4068] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
A 60-year-old man presented with chest discomfort with fever and high C-reactive protein (CRP). Chest computed tomography (CT) disclosed a mediastinal soft tissue swelling originating from the aortic arch, and gallium-67 single-photon emission CT revealed intense uptake in the same region. We initially suspected mediastinitis and/or a thoracic aortic infection. Antibiotics improved his symptoms and CRP levels. However, a follow-up CT scan 33 days later, revealed an aortic arch aneurysm and the patient was diagnosed with infective aortic aneurysm. Here, we report a rare case of a rapidly progressing aneurysm of infected aorta aortic infection with pseudoaneurysm formation.
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Affiliation(s)
- Akio Iimori
- Department of Internal Medicine III, Osaka Medical College, Takatsuki, Japan
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