1
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Pham R, Chou E, Breiner D, Wei J, Mandava V, Bui D. Rare case of inflammatory abdominal aortic aneurysm with an aortocaval fistula. Radiol Case Rep 2024; 19:114-116. [PMID: 37941987 PMCID: PMC10628783 DOI: 10.1016/j.radcr.2023.09.075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Revised: 09/18/2023] [Accepted: 09/25/2023] [Indexed: 11/10/2023] Open
Abstract
Inflammatory abdominal aortic aneurysms (IAAA) are a distinct subcategory of abdominal aortic aneurysms that make up roughly 5%-10% of all abdominal aortic aneurysm (AAA) cases. Inflammatory AAA (IAAA) is distinguished from traditional atherosclerotic AAA by the triad of thickened aneurysm wall, extensive perianeurysmal/retroperitoneal fibrosis, and dense adhesions of adjacent abdominal organs. The purpose of this report is to examine the clinical course of a rare case of inflammatory abdominal aortic aneurysm with aortocaval fistula.
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Affiliation(s)
- Richard Pham
- University of California Riverside School of Medicine, Riverside, CA, USA
| | - Edwin Chou
- University of California Riverside School of Medicine, Riverside, CA, USA
| | - Derek Breiner
- University of California Riverside School of Medicine, Riverside, CA, USA
| | - Justin Wei
- University of California Riverside School of Medicine, Riverside, CA, USA
| | - Veena Mandava
- University of California Riverside School of Medicine, Riverside, CA, USA
| | - Duy Bui
- University of California Riverside School of Medicine, Riverside, CA, USA
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2
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Diepenbruck SD, Jakob A, Haas NA, Mandilaras G. Endovascular treatment of a mycotic aneurysm in an immunocompromised child with acute leukemia-case report and review of the literature. Front Pediatr 2023; 11:1136647. [PMID: 37842028 PMCID: PMC10568310 DOI: 10.3389/fped.2023.1136647] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Accepted: 09/08/2023] [Indexed: 10/17/2023] Open
Abstract
Mycotic aneurysms are dilatations of an artery, a rare but severe complication arising from infectious obliteration of the vessel wall. Thoracic aneurysms often present with unspecific symptoms and multiple diagnostic and therapeutic challenges. In an advanced state, they have an increased risk of perforation and a high mortality rate. The surgical therapeutic approach has a high perioperative complication rate. In this study, we report a case of a thoracic mycotic aortic aneurysm in an immunocompromised pediatric patient caused by Klebsiella pneumoniae bacteremia. A combination of prompt antibacterial treatment and minimally invasive stent implantation showed a good outcome, avoiding possible severe surgical problems.
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Affiliation(s)
| | | | | | - Guido Mandilaras
- Division of Pediatric Cardiology and Pediatric Intensive Care, University Hospital of Munich (LMU), Munich, Germany
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3
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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: 14] [Impact Index Per Article: 14.0] [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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4
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Nagahata K, Kamiya H, Takahashi H. A Rapidly Progressive Aortic Aneurysm Due to Escherichia Coli. Am J Med 2023; 136:e109-e110. [PMID: 36828215 DOI: 10.1016/j.amjmed.2023.01.041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2023] [Accepted: 01/23/2023] [Indexed: 02/24/2023]
Affiliation(s)
- Ken Nagahata
- Department of Rheumatology and Clinical Immunology, School of Medicine, Sapporo Medical University, Sapporo, Japan; Department of Internal Medicine, JYUKEIKAI Ishida Hospital, Nakashibetsu, Japan.
| | - Hiroyuki Kamiya
- Department of Cardiac Surgery, School of Medicine, Asahikawa Medical University, Asahikawa, Japan
| | - Hiroki Takahashi
- Department of Rheumatology and Clinical Immunology, School of Medicine, Sapporo Medical University, Sapporo, Japan
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5
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Mao Y, Wang C, Li Y, Guan X, Zhang X, Wu X. Percutaneous closure versus surgical repair for ruptured sinus of valsalva aneurysm: A systematic review and meta-analysis. Front Cardiovasc Med 2023; 10:1158906. [PMID: 37139136 PMCID: PMC10150332 DOI: 10.3389/fcvm.2023.1158906] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2023] [Accepted: 03/13/2023] [Indexed: 05/05/2023] Open
Abstract
Objectives Ruptured sinus of Valsalva aneurysm (RSVA) often has an abrupt onset, and can chest pain, acute heart failure, and even sudden death. The effectiveness of different treatment modalities remains controversial. Thus, we completed a meta-analysis to evaluate the efficiency and safety of traditional surgery vs. percutaneous closure (PC) for RSVA. Methods We carried out a meta-analysis using PubMed, Embase, Web of Science, Cochrane Library, China National Knowledge Infrastructure (CNKI), WanFang Data, and the China Science and Technology Journal Database. The primary outcome was comparing in-hospital mortality between the two procedures, and the secondary outcome was documenting postoperative residual shunts, postoperative aortic regurgitation, and length of hospital stay in the two groups. Differences were expressed as odds ratios (ORs) with 95% confidence intervals (CIs) to assess the relationships between predefined surgical variables and clinical outcomes. This meta-analysis was conducted using Review Manager software (version 5.3). Results The final qualifying studies included 330 patients from 10 trials (123 in the percutaneous closure group, and 207 in the surgical repair group). When PC was compared to surgical repair, there were no statistically significant differences in in-hospital mortality (overall OR: 0.47, 95%CI 0.05-4.31, P = 0.50). However, percutaneous closure did significantly decrease the average length of hospital stay (OR: -2.13, 95% CI -3.05 to -1.20, P < 0.00001) when compared to surgical repair, but there were no significant between-group differences in the rates of postoperative residual shunts (overall OR: 1.54, 95%CI 0.55-4.34, P = 0.41) or postoperative aortic regurgitation (overall OR: 1.54, 95%CI 0.51-4.68, P = 0.45). Conclusion PC may become a valuable alternative to surgical repair for RSVA.
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Affiliation(s)
- Yong Mao
- Department of Cardiac Surgery, Lanzhou University Second Hospital, Lanzhou University, Lanzhou, China
| | - Cingting Wang
- Health Science Center of Lanzhou University, Lanzhou University, Lanzhou, China
- Dongguan Tungwah Hospital, Dongguan, China
| | - Yongnan Li
- Department of Cardiac Surgery, Lanzhou University Second Hospital, Lanzhou University, Lanzhou, China
| | - Xinqiang Guan
- Department of Cardiac Surgery, Lanzhou University Second Hospital, Lanzhou University, Lanzhou, China
| | - Xiaopeng Zhang
- Department of Cardiac Surgery, Lanzhou University Second Hospital, Lanzhou University, Lanzhou, China
| | - Xiangyang Wu
- Department of Cardiac Surgery, Lanzhou University Second Hospital, Lanzhou University, Lanzhou, China
- Correspondence: Xiangyang Wu
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6
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Muacevic A, Adler JR. Mycotic Thoracic Aortic Aneurysm: Epidemiology, Pathophysiology, Diagnosis, and Management. Cureus 2022; 14:e31010. [PMID: 36349070 PMCID: PMC9632233 DOI: 10.7759/cureus.31010] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/29/2022] [Indexed: 11/30/2022] Open
Abstract
Mycotic thoracic aortic aneurysm (MTAA) is an aneurysm of the aorta caused by infection of the vessel tissue through microbial inoculation of the diseased aortic endothelium. It is most commonly caused by bacteria. Rarely, it can be caused by fungi. However, viral aortic aneurysm has never been reported. Depending on the area and time period investigated, the infections organism discovered may vary significantly. Little is known about the natural history of MTAA due to its rarity. It is not known if they follow the same pattern as other TAAs. However, it is unclear whether MTAA follows a similar clinical course. The combination of clinical presentation, laboratory results, and radiographic results are used to make the diagnosis of MTAA. Treatment of MTAA is complex since patients frequently present at a late stage, frequently with fulminant sepsis, as well as concomitant complications such as aneurysm rupture. While medical treatment, including antibiotics, is recommended, surgery is still the mainstay of management. Surgery to treat MTAA is complicated and carries a high risk of morbidity and mortality and includes both open repairs and endovascular ones. In this review, we explore the etiology, pathogenesis, clinical presentations, diagnostic modalities as well as treatment management available for MTAA.
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Liu S, Liao Y, Liu C, Zhou H, Chen G, Lu W, Huang Z. Identification of a miRSNP Regulatory Axis in Abdominal Aortic Aneurysm by a Network and Pathway-Based Integrative Analysis. OXIDATIVE MEDICINE AND CELLULAR LONGEVITY 2022; 2022:8776566. [PMID: 36275900 PMCID: PMC9586150 DOI: 10.1155/2022/8776566] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Revised: 08/18/2022] [Accepted: 08/23/2022] [Indexed: 11/26/2022]
Abstract
Abdominal aortic aneurysm (AAA) refers to local abnormal expansion of the abdominal aorta and mostly occurs in elderly men. MicroRNA (miRNA) is single-stranded RNA consisting of 18-25 nucleotides. It plays a key role in posttranscriptional gene expression and in the regulation of human functions and disease development. miRNA exerts its function mainly through the binding of complementary base pairs to the 3' regulatory region of mRNA transcripts. Therefore, miRNA-related single-nucleotide polymorphisms (miRSNPs) can affect miRNA expression and processing kinetics. miRSNPs can be classified based on their location: miRSNPs within miRNA-producing genes and miRSNPs within miRNA target genes. Increasing evidence indicates that miRSNPs play an important role in the pathogenic kinetics of cardiovascular diseases. The aim of this study was to identify potential miRNAs and integrate them into a miRSNP-based disease-related pathway network, the results of which are of great significance to the interpretation of the potential mechanisms and functions of miRSNPs in the pathogenesis of diseases.
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Affiliation(s)
- Shenrong Liu
- Department of Cardiology, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong 510120, China
| | - Yanfen Liao
- Department of Stomatology, The Second People's Hospital of Panyu Guangzhou, Guangdong 511470, China
| | - Changsong Liu
- Department of Cardiology, The Second Affiliated Hospital, Army Medical University, Chongqing 400000, China
| | - Haobin Zhou
- Department of Cardiology, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong 510120, China
| | - Gui Chen
- State Key Laboratory of Respiratory Disease, Department of Otolaryngology-Head and Neck Surgery, First Affiliated Hospital, Guangzhou Medical University, Guangzhou, Guangdong 510120, China
| | - Weiling Lu
- Department of Cardiology, Ganzhou Municipal Hospital, 49th, Grand Highway, 341000 Ganzhou, China
| | - Zheng Huang
- Department of Cardiology, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong 510120, China
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Husmann L, Huellner MW, Gruenig H, Ledergerber B, Messerli M, Mestres CA, Rancic Z, Hasse B. Imaging characteristics and diagnostic accuracy of FDG-PET/CT, contrast enhanced CT and combined imaging in patients with suspected mycotic or inflammatory abdominal aortic aneurysms. PLoS One 2022; 17:e0272772. [PMID: 35944039 PMCID: PMC9362916 DOI: 10.1371/journal.pone.0272772] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2022] [Accepted: 07/27/2022] [Indexed: 11/30/2022] Open
Abstract
Purpose To evaluate the diagnostic accuracy and specific imaging characteristics of positron emission tomography/computed tomography with 18F-fluorodeoxyglucose (PET/CT), contrast enhanced CT (CE-CT), and a combined imaging approach (CE-PET/CT) in patients with infectious/mycotic (MAA), inflammatory (IAA), and non-infected, non-inflammatory abdominal aortic aneurysm (AAA). Materials and methods In this single-center retrospective cohort study, all imaging data sets of 29 consecutive patients with clinically suspected MAA or IAA were anonymised with different, reshuffled identification numbers and retrospectively and independently analysed by two experienced readers, blinded to all clinical patient data. Readers determined the presence or absence and MAA, IAA and AAA and of predefined imaging characteristics (e.g. fluid collection), and measured metabolic activity and wall thickness of all aneurysms. A multidisciplinary team of specialists served as standard of reference and re-evaluated every clinical case, considering all clinical, laboratory, microbiological, histopathological and imaging results, including all follow-up examinations. Results Diagnostic accuracy was higher in PET/CT as compared to CE-CT in differentiating AAA from MAA and IAA: area under the receiver operating characteristic curve (AUC-ROC) 0.81 (95% confidence intervals 0.69–0.92) and 0.63 (0.52–0.74) (P = 0.027). Specific imaging characteristics were significantly associated with different types of aneurysms (P<0.05), i.e. very high metabolic activity and dorsal sparing of metabolic activity in PET/CT and wall thickening in CE-CT were indicative for IAA; fat stranding and fluid collections in CE-CT were associated with MAA; while low metabolic acitivity and absence of wall thickening in PET/CT, and less fat stranding and absence of wall thickening in CE-CT were indicative for non-infected, non-inflammatory AAA. Conclusion Specific imaging characteristics of PET/CT and CE-CT may be helpful in differentiating between MAA, IAA, and non-infected, non-inflammatory AAA.
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Affiliation(s)
- Lars Husmann
- Department of Nuclear Medicine, University Hospital Zurich, University of Zurich, Zurich, Switzerland
- * E-mail:
| | - Martin W. Huellner
- Department of Nuclear Medicine, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Hannes Gruenig
- Department of Nuclear Medicine, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Bruno Ledergerber
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Michael Messerli
- Department of Nuclear Medicine, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Carlos-A. Mestres
- Clinic for Cardiac Surgery, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Zoran Rancic
- Department of Vascular Surgery, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Barbara Hasse
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
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Pitchai S, Pandey A, Sun N, Manchikanti S. Ruptured mycotic abdominal aortic aneurysm with perforated colonic malignancy – “Quadruple Jeopardy”. INDIAN JOURNAL OF VASCULAR AND ENDOVASCULAR SURGERY 2022. [DOI: 10.4103/ijves.ijves_1_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
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10
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Inflammatory abdominal aortic aneurysms treated with leflunomide: an eight-year follow-up case report and literature review. JOURNAL OF GERIATRIC CARDIOLOGY : JGC 2021; 18:847-850. [PMID: 34754297 PMCID: PMC8558739 DOI: 10.11909/j.issn.1671-5411.2021.10.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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11
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Eosinophilic Granulomatosis Polyangiitis (EGPA) Masquerading as a Mycotic Aneurysm of the Abdominal Aorta: Case Report and Review of Literature. Case Rep Rheumatol 2021; 2021:7093607. [PMID: 34552804 PMCID: PMC8452388 DOI: 10.1155/2021/7093607] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2021] [Accepted: 09/01/2021] [Indexed: 11/17/2022] Open
Abstract
Introduction Aortic involvement leading to aortitis in eosinophilic granulomatosis polyangiitis (EGPA) is infrequent, and only 2 cases have been reported so far in the literature. Even more so, aortic aneurysm, secondary to EGPA, has never been reported and remains a diagnostic and therapeutic challenge. Case Presentation. We present a 63-year-old Caucasian male patient with a prior diagnosis of EGPA presenting with abdominal pain, nausea, and loose stools to the emergency department. Physical examination showed periumbilical tenderness. He had no peripheral eosinophilia but had high C-reactive protein and procalcitonin levels. CT abdomen revealed a mycotic aneurysm involving the infrarenal abdominal aorta. The patient declined surgical repair initially and was treated with IV antibiotics only. Unfortunately, 24 hours later, the aneurysm ruptured, leading to emergent axillofemoral bypass surgery. Surgical biopsy showed aortitis, periaortitis, and active necrotizing vasculitis. Conclusion Abdominal aneurysms should be considered a complication of EGPA, and earlier immunosuppressive therapy should be considered to prevent further complications.
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Murali S, Wang SS, Grenier MA, Revels JW. "Undiagnosed aortic coarctation with 2 simultaneous acute aortic syndromes: Intramural hematoma and mycotic aneurysm". Radiol Case Rep 2021; 16:2934-2937. [PMID: 34401029 PMCID: PMC8350181 DOI: 10.1016/j.radcr.2021.07.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Revised: 07/06/2021] [Accepted: 07/06/2021] [Indexed: 11/17/2022] Open
Abstract
Acute aortic syndrome can be a fatal pathology if not diagnosed and managed early. Although acute aortic syndrome is more often a diagnosis of adulthood, it may occasionally afflict the pediatric patients. We herein present a case of a 5-year-old female that was discovered to have multiple acute and congenital aortic abnormalities after presenting to the emergency department with infectious symptoms and lower extremity pain. Acute aortic syndrome may not be a top differential consideration in children with acute chest pain; however, it is important to consider because delayed diagnosis and management can have fatal implications.
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Affiliation(s)
- Sowmiya Murali
- Department of Radiology, University of New Mexico, MSC 10 5530, 1, Albuquerque, NM 87131, USA
| | - Sherry S Wang
- Department of Radiology and Imaging Sciences, University of Utah, Salt Lake City, UT, USA
| | - Michelle A Grenier
- Department of Radiology, University of New Mexico, MSC 10 5530, 1, Albuquerque, NM 87131, USA
| | - Jonathan W Revels
- Department of Radiology, University of New Mexico, MSC 10 5530, 1, Albuquerque, NM 87131, USA
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13
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Kwok HM, Luk WH, Cheng LF, Pan NY, Chan HF, Ma JKF. Gallium-67 Scan with Single Photon Emission Computed Tomography for the Evaluation and Monitoring of Infected Abdominal Aortic Aneurysms: A 10-Year Case Series. Vasc Specialist Int 2021; 37:17. [PMID: 34183473 PMCID: PMC8239215 DOI: 10.5758/vsi.210020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Revised: 05/19/2021] [Accepted: 06/14/2021] [Indexed: 12/03/2022] Open
Abstract
Purpose This study aimed to evaluate the role of gallium-67 single photon emission computed tomography (SPECT) with contrast computed tomography (CT) in the evaluation and monitoring of infected abdominal aortic aneurysms (IAAA). Methods Materials and A retrospective cohort analysis was performed using prospectively collected data of consecutive patients with IAAA in Princess Margaret Hospital in Hong Kong between January 2010 and December 2020. The patients were identified using the Radiology Information System. Results All five patients had proven IAAA on CT and/or metabolic imaging. Among them, three were further supported by positive blood culture results. Gallium-67 SPECT with contrast CT was useful in the detection of residual disease, monitoring, and detection of recurrence. Conclusion Gallium-67 SPECT with contrast CT is helpful for evaluating IAAA. It serves an important role in guiding management, especially during long-term follow-up.
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Affiliation(s)
- Hoi-Ming Kwok
- Department of Diagnostic and Interventional Radiology, Princess Margaret Hospital, Hong Kong, China
| | - Wing-Hang Luk
- Department of Diagnostic and Interventional Radiology, Princess Margaret Hospital, Hong Kong, China
| | - Lik-Fai Cheng
- Department of Diagnostic and Interventional Radiology, Princess Margaret Hospital, Hong Kong, China
| | - Nin-Yuan Pan
- Department of Diagnostic and Interventional Radiology, Princess Margaret Hospital, Hong Kong, China
| | - Ho-Fung Chan
- Department of Diagnostic and Interventional Radiology, Princess Margaret Hospital, Hong Kong, China
| | - Johnny Ka-Fai Ma
- Department of Diagnostic and Interventional Radiology, Princess Margaret Hospital, Hong Kong, China
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14
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Infections of the aorta. Indian J Thorac Cardiovasc Surg 2021; 38:101-114. [PMID: 35463716 PMCID: PMC8980989 DOI: 10.1007/s12055-021-01173-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Revised: 02/21/2021] [Accepted: 02/23/2021] [Indexed: 10/21/2022] Open
Abstract
Infection of the aorta continues to be a clinical challenge with high morbidity and mortality. The incidence varies between 0.6 and 2.6%. There has been a steady increase in graft infections, especially endograft infections, due to increased procedures (0.2 to 5%). Staphylococcus species remains the most common organism; however, gram-negative and rare causative agents are also reported. The clinical presentation can be very diverse and a high degree of suspicion is necessary to diagnose them. Sometimes, they may present as an emergency with rupture or fistulation. Diagnosis is based on a triad of clinical features, microbial cultures and imaging. Culture-specific antibiotics are mandatory during the entire course, but seldom cure alone. Surgical management remains the standard of care and involves an integrated approach involving debridement, reconstruction and use of adjuncts. Various aortic substitutes have been described with advantages and limitations. Pericardial tube grafts have emerged as a good option. Endo-vascular options are practiced mostly as a bridge to definitive surgery. A small role for conservative management is described. Aortic fistulation to the gut and airway carries a very high mortality. There are no large series in the literature to define guideline-directed treatment and most often it is a customized solution. The 30-day mortality remains close to 30%. Outcomes depend on multiple factors including patient's age, the timing of presentation, diagnosis, causative organism, host status and the treatment strategy adopted.
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15
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Jaswal V, Kumar V, Thingnam SKS, Puri GD. Surgical repair of ruptured sinus of Valsalva aneurysm: 13-year single center experience. J Card Surg 2021; 36:1264-1269. [PMID: 33476446 DOI: 10.1111/jocs.15358] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Revised: 12/17/2020] [Accepted: 12/18/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND AND AIM Untreated ruptured sinus of Valsalva aneurysms ultimately develop into heart failure, thereby affecting patients' survival. We retrospectively analyzed our 13-year experience of the surgical repair for ruptured sinus of Valsalva aneurysm to study the optimal surgical strategy, operative risk and long-term surgical outcome. METHODS Twenty-six patients underwent surgical repair of ruptured sinus of Valsalva aneurysm from January 2008 to February 2020. Follow-up data were obtained from the outpatient department records and telephone calls. RESULTS Patch closure of ruptured sinus of Valsalva aneurysm was done in all the 26 patients, most often through the transaortic (69%) and dual-chamber approach (23%). Aortic valve repair was done in one patient while seven patients underwent aortic valve replacement for associated significant aortic regurgitation. There was one in-hospital mortality because of noncardiac cause. The median duration of postoperative hospital stay was 8 days (range, 6-11 days). Follow-up data were available for 89% (23/26) patients. The mean follow-up period was 69 ± 43 months (range, 7-147 months). All survivors were in New York Heart Association functional Class I or II. There was no late death. One patient required rehospitalization for recurrent ruptured sinus of Valsalva aneurysm. There was no recurrent or new-onset significant aortic regurgitation and prosthesis-related complications in late follow-up. CONCLUSION Surgical repair for ruptured sinus of Valsalva aneurysm carries an acceptable low operative risk and excellent long-term outcome. Though high-risk population, an early diagnosis and optimal surgical approach can prevent worsening of symptoms and consequent heart failure.
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Affiliation(s)
- Vivek Jaswal
- Department of Cardiovascular and Thoracic Surgery, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Vikas Kumar
- Department of Cardiovascular and Thoracic Surgery, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Shyam K S Thingnam
- Department of Cardiovascular and Thoracic Surgery, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Goverdhan D Puri
- Department of Anaesthesia and Intensive Care, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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16
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(The Role of PET/CT in Angiology). COR ET VASA 2020. [DOI: 10.33678/cor.2020.037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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17
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Cho J, Bang JH, Jeong SS, Yi J, Yoon SS, Cho K. Clinical Outcomes of Atypical Inflammatory Variants of Abdominal Aortic Aneurysm. THE KOREAN JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY 2020; 53:353-360. [PMID: 33115973 PMCID: PMC7721529 DOI: 10.5090/kjtcs.20.068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Revised: 09/02/2020] [Accepted: 09/19/2020] [Indexed: 11/16/2022]
Abstract
Background Most abdominal aortic aneurysms are degenerative atherosclerotic aneurysms. Inflammatory or infected abdominal aortic aneurysms, which show a slightly different clinical course, are rarely encountered in clinical settings. Therefore, we aimed to investigate the clinical course of these variants of abdominal aortic aneurysms. Methods This retrospective study included 32 patients with atypical inflammatory or infected abdominal aortic aneurysms who underwent emergent graft replacement between November 1997 and December 2017. Patients were followed up at the outpatient clinic for a mean period of 4.9±6.9 years. We analyzed the patients' clinical course and compared it with that of patients with atherosclerotic abdominal aortic aneurysms. Results There was 1 surgical mortality (3.0%) in a case complicated by aneurysmal free rupture. In 2 cases of infected abdominal aortic aneurysms, anastomotic complications developed immediately postoperatively. During the follow-up period, 10 patients (30%) developed graft complications, and 9 of them underwent reoperations; of these, 2 patients (22.2%) died of postoperative complications after the second operation, whereas 2 patients survived despite graft occlusion. Conclusion Patients with inflammatory abdominal aneurysms frequently develop postoperative graft complications requiring secondary surgical treatment, so they require close mandatory postoperative follow-up.
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Affiliation(s)
- JooHyun Cho
- Department of Thoracic and Cardiovascular Surgery, Dong-A University College of Medicine, Busan, Korea
| | - Jung Hee Bang
- Department of Thoracic and Cardiovascular Surgery, Dong-A University College of Medicine, Busan, Korea
| | - Sang Seok Jeong
- Department of Thoracic and Cardiovascular Surgery, Dong-A University College of Medicine, Busan, Korea
| | - Junghoon Yi
- Department of Thoracic and Cardiovascular Surgery, Dong-A University College of Medicine, Busan, Korea
| | - Sung Sil Yoon
- Department of Thoracic and Cardiovascular Surgery, Dong-A University College of Medicine, Busan, Korea
| | - Kwangjo Cho
- Department of Thoracic and Cardiovascular Surgery, Dong-A University College of Medicine, Busan, Korea
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Yodsanit N, Wang B, Zhao Y, Guo LW, Kent KC, Gong S. Recent progress on nanoparticles for targeted aneurysm treatment and imaging. Biomaterials 2020; 265:120406. [PMID: 32979792 DOI: 10.1016/j.biomaterials.2020.120406] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Revised: 09/14/2020] [Accepted: 09/18/2020] [Indexed: 02/06/2023]
Abstract
An abdominal aortic aneurysm (AAA) is a localized dilatation of the aorta that plagues millions. Its rupture incurs high mortality rates (~80-90%), pressing an urgent need for therapeutic methods to prevent this deadly outcome. Judiciously designed nanoparticles (NPs) have displayed a unique potential to fulfill this need. Aneurysms feature excessive inflammation and extracellular matrix (ECM) degradation. As such, typically inflammatory cells and exposed ECM proteins have been targeted with NPs for therapeutic, diagnostic, or theranostic purposes in experimental models. NPs have been used not only for encapsulation and delivery of drugs and biomolecules in preclinical tests, but also for enhanced imaging to monitor aneurysm progression in patients. Moreover, they can be readily modified with various molecules to improve lesion targeting, detectability, biocompatibility, and circulation time. This review updates on the progress, limitations, and prospects of NP applications in the context of AAA.
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Affiliation(s)
- Nisakorn Yodsanit
- Department of Biomedical Engineering, And Wisconsin Institute for Discovery, University of Wisconsin-Madison, Madison, WI, 53715, USA
| | - Bowen Wang
- Department of Surgery, School of Medicine, University of Virginia, Charlottesville, VA, 22903, USA
| | - Yi Zhao
- Department of Biomedical Engineering, And Wisconsin Institute for Discovery, University of Wisconsin-Madison, Madison, WI, 53715, USA
| | - Lian-Wang Guo
- Department of Surgery, School of Medicine, University of Virginia, Charlottesville, VA, 22903, USA.
| | - K Craig Kent
- Department of Surgery, School of Medicine, University of Virginia, Charlottesville, VA, 22903, USA.
| | - Shaoqin Gong
- Department of Biomedical Engineering, And Wisconsin Institute for Discovery, University of Wisconsin-Madison, Madison, WI, 53715, USA; Department of Material Science and Engineering and Department of Chemistry, University of Wisconsin-Madison, Madison, WI, 53715, USA.
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Di X, Liu C, Zeng R, Ni L. Endovascular Aortic Repair Is a Viable Strategy for Treatment of Primary Infected Abdominal Aortic Aneurysm. Ann Vasc Surg 2020; 63:117-128. [DOI: 10.1016/j.avsg.2018.12.080] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2018] [Revised: 12/04/2018] [Accepted: 12/05/2018] [Indexed: 11/26/2022]
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20
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Kozaki S, Miyamoto S, Uchida K, Shuto T, Tanaka H, Wada T, Anai H. Infected thoracic aortic aneurysm caused by Clostridium ramosum: A case report. J Cardiol Cases 2019; 20:103-105. [PMID: 31497176 DOI: 10.1016/j.jccase.2019.06.005] [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] [Received: 09/10/2018] [Revised: 02/03/2019] [Accepted: 06/10/2019] [Indexed: 02/08/2023] Open
Abstract
A 73-year-old man undergoing conservative management of acute aortic dissection (Stanford type B) was diagnosed with infected aortic aneurysm based on clinical findings of aortic dilatation and recurrent laryngeal nerve paralysis. We performed total aortic arch replacement with a synthetic graft and omentopexy; and Clostridium ramosum was isolated from resection specimens. Infected aortic aneurysms are rare but may lead to death from aortic dissection or rupture. C. ramosum infection is rare and has seldom been reported, and thus no treatment guidelines, including antibiotic therapy, have been established. Therefore, it is necessary to accumulate a larger number of cases of aortic aneurysm infected by C. ramosum. To date, there has been no reported case of infected aortic aneurysm due to C. ramosum. Here, we report a case of infected aortic aneurysm due to C. ramosum. <Learning objective: Infected aortic aneurysm is a life-threatening condition because of the possibility of aortic dissection and rupture. Infected aortic aneurysms are often caused by Staphylococcus aureus and Salmonella species, and there has been no report of aortic aneurysm infected by C. ramosum. Regarded as a non-pathogenic intestinal bacterium, C. ramosum is seldom identified as a causative bacterium. In this case, dilatation of aorta progressed rapidly, requiring early surgical treatment.>.
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Affiliation(s)
- Satoshi Kozaki
- Department of Cardiovascular Surgery, Oita University Hospital, Japan
| | - Shinji Miyamoto
- Department of Cardiovascular Surgery, Oita University Hospital, Japan
| | - Kaoru Uchida
- Department of Cardiovascular Surgery, Oita University Hospital, Japan
| | - Takashi Shuto
- Department of Cardiovascular Surgery, Oita University Hospital, Japan
| | - Hideyuki Tanaka
- Department of Cardiovascular Surgery, Oita University Hospital, Japan
| | - Tomoyuki Wada
- Department of Cardiovascular Surgery, Oita University Hospital, Japan
| | - Hirofumi Anai
- Department of Clinical Engineering, Oita University Faculty of Medicine, Japan
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21
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Bouzas M, Ponte C, Van Houte B, Vasquez C. Mycotic aortic aneurysms treated by endovascular repair: initial experience in a single center. Acta Chir Belg 2019; 119:189-194. [PMID: 29382272 DOI: 10.1080/00015458.2018.1432741] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
INTRODUCTION Mycotic aortic aneurysm (MAA) is an uncommon cause of aneurysmal aortic disease. However, it may have an aggressive presentation and a complicated early outcome. Endovascular aneurysm repair (EVAR) of MAA is emerging as an alternative to open repair (OR) for the treatment of these aneurysms, particularly in high-risk surgical patients. We report a single-center experience with the endovascular management of mycotic aortic aneurysms. MATERIAL AND METHODS Two mycotic abdominal aortic aneurysms were treated with an endovascular stent graft at Centre Hospitalier Régional du Val de Sambre, Belgium. The mean follow-up was 15 months. Technical success was achieved in all two patients. CT-scan follow up showed shrinkage of the aneurysm sac, with no evidence of infection along the stent graft and no signs of endoleakage in all patients. One patient died during the follow-up period from a cause unrelated to the aneurysm. CONCLUSION EVAR is an effective and safe option and might be a suitable alternative to OR in the absence of predictors of poor prognosis for the treatment of non-complicated forms of MAA.
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Affiliation(s)
- Miguel Bouzas
- Centre Hospitalier Universitaire de Liege, Liège, Belgium
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22
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Veraldi GF, Mezzetto L, Scorsone L, Sacco M, Eccher A, Idolazzi L. Surgical Treatment of Symptomatic Aortic Aneurysm in a Patient with Anti-neutrophil Cytoplasmic Antibody-associated Vasculitis: Case Report and Review of the Literature. Ann Vasc Surg 2018; 53:270.e17-270.e21. [PMID: 30092440 DOI: 10.1016/j.avsg.2018.05.060] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2018] [Revised: 05/09/2018] [Accepted: 05/10/2018] [Indexed: 11/16/2022]
Abstract
Vasculitis is an heterogeneous group of syndromes, which shares inflammation of blood vessel wall as the main feature. Anti-neutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV) is a necrotizing vasculitis, with few or no immune deposits, predominantly affecting small vessels (i.e., capillaries, venules, arterioles, and small arteries), associated with ANCAs specific for myeloperoxidase or proteinase 3. Clinical manifestations may be heterogeneous but an involvement of lungs and kidneys frequently occurs. AAV of large vessels is a very rare condition whose standard therapy is medical approach. Surgical revascularization has been described in selected patients after medical failure or in emergent settings. We report the case of a patient affected by symptomatic infrarenal aortic aneurysm related to AAV, who underwent in-situ reconstruction by means of cryopreserved homograft.
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Affiliation(s)
- Gian Franco Veraldi
- Department of Vascular Surgery, University Hospital of Verona, Verona, Italy
| | - Luca Mezzetto
- Department of Vascular Surgery, University Hospital of Verona, Verona, Italy.
| | - Lorenzo Scorsone
- Department of General and Upper Gastrointestinal Surgery, University Hospital of Verona, Verona, Italy
| | - Michele Sacco
- Department of General and Upper Gastrointestinal Surgery, University Hospital of Verona, Verona, Italy
| | - Albino Eccher
- Department of Diagnostic and Pathology, University Hospital of Verona, Verona, Italy
| | - Luca Idolazzi
- Department of Rheumatology, University Hospital of Verona, Verona, Italy
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23
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Sailer AM, Bakers FC, Daemen JW, Vöö S. 18F-FDG PET/MRI in the diagnosis of an infected aortic aneurysm. Cardiovasc Diagn Ther 2018; 8:S208-S211. [PMID: 29850433 DOI: 10.21037/cdt.2017.08.05] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
We report a case where an integrated whole body 18F-fluorodeoxyglucose (18F-FDG) positron emission tomography (PET)/magnetic resonance imaging (MRI) is performed in the diagnostic work-up of a saccular aortic aneurysm. The integrated whole body 18F-FDG PET/MRI study answered all relevant diagnostic questions, clearly marking an infected aortic aneurysm, depicting the extent of the infected area in relation to the aortic branch vessels, and indicating the aortic lesion as the primary site of infection. The patient was successfully treated by open type V TAAA repair and pericardial graft replacement. Aortic wall infection was proven in cultures of the surgical specimen.
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Affiliation(s)
- Anna M Sailer
- Department of Radiology, Maastricht University Medical Centre, Maastricht, the Netherlands.,Department of Radiology, Stanford University School of Medicine, Stanford, USA
| | - Frans C Bakers
- Department of Radiology, Maastricht University Medical Centre, Maastricht, the Netherlands
| | - Jan W Daemen
- Department of Vascular Surgery, Maastricht University Medical Centre, Maastricht, the Netherlands
| | - Stefan Vöö
- Department of Nuclear Medicine, Maastricht University Medical Centre, Maastricht, the Netherlands.,Department of Nuclear Medicine, University College London Hospitals, London, UK
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24
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Berniker AV, Mackey JE, Teytelboym OM. Intimal Problems: A Pictorial Review of Nontraumatic Aortic Disease at Multidetector Computed Tomography. Curr Probl Diagn Radiol 2018; 47:51-60. [DOI: 10.1067/j.cpradiol.2015.08.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2015] [Revised: 08/10/2015] [Accepted: 08/10/2015] [Indexed: 11/22/2022]
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25
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Bedmutha AS, Singh N, Shivdasani D. Metabolic Imaging as a Novel Strategy in Evaluation of Mycotic Abdominal Aortic Aneurysm: A Case Report and Brief Clinical Review. Indian J Nucl Med 2017; 32:336-339. [PMID: 29142353 PMCID: PMC5672757 DOI: 10.4103/ijnm.ijnm_81_17] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Abdominal aortic aneurysm (AAA) is an uncommon entity with high mortality. Etiologically, they are classified as inflammatory and infective (mycotic), the latter being less common. Clinical presentation, laboratory investigations, and treatment for these may considerably overlap. However, choice of management and the need for surgical intervention depends on factors such as size and progression of aneurysm, persistent symptoms, and presence or absence of distant pathology. Although computed tomography (CT) is the gold standard for AAA, in selected cases, especially in infected AAA, fluorodeoxyglucose positron emission tomography-CT can provide valuable information.
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Affiliation(s)
- Akshay Sharad Bedmutha
- Department of Nuclear Medicine and PET/CT, P. D. Hinduja National Hospital and Medical Research Centre, Mumbai, Maharashtra, India
| | - Natasha Singh
- Department of Nuclear Medicine and PET/CT, P. D. Hinduja National Hospital and Medical Research Centre, Mumbai, Maharashtra, India
| | - Divya Shivdasani
- Department of Nuclear Medicine and PET/CT, P. D. Hinduja National Hospital and Medical Research Centre, Mumbai, Maharashtra, India
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26
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Duque Santos Á, Reyes Valdivia A, Romero Lozano MA, Aracil Sanus E, Ocaña Guaita J, Gandarias C. Outcomes of open and endovascular repair of inflammatory abdominal aortic aneurysms. Vascular 2017; 26:203-208. [PMID: 28841130 DOI: 10.1177/1708538117728865] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Objective Reports on inflammatory aortic abdominal aneurysm treatment are scarce. Traditionally, open surgery has been validated as the gold standard of treatment; however, high technical skills are required. Endovascular aortic repair has been suggested as a less invasive treatment by some authors offering good results. The purpose of our study was to report our experience and outcomes in the treatment of inflammatory aortic abdominal aneurysm using both approaches. Material and methods A retrospective review and data collection of all patients treated for inflammatory aortic abdominal aneurysm between 2000 and 2015 was done in one academic center. Diagnosis of inflammatory aortic abdominal aneurysm was based on preoperative CT-scan imaging. Type of treatment, postoperative and long-term morbidity and mortality are described. Abdominal compressive symptoms (hydronephrosis) severity and relief after treatment are described. Results Thirty-four patients with intact inflammatory aortic abdominal aneurysm were included. Twenty-nine (85.3%) patients were treated by open means and the remaining five (14.7%) with endovascular aortic repair. Nearly 90% were considered high-risk patients. Median follow-up was 46 months (range 24-112). The two groups were comparable, except for the age and preoperative hydronephrosis. There was no statistical significance in blood transfusion requirements, intensive care hospitalization, 30-day and long-term mortality between the two groups. Preoperative hydronephrosis was diagnosed in four (13.8%) patients in the open surgery group and three (60%) patients in the endovascular aortic repair group. Improvement of hydronephrosis was recognized in three out of the four patients in the open repair group and two out of the three in the endovascular aortic repair group. Renal function remained stable in both groups during follow-up. Conclusions Open surgery remains a safe and valid option for the treatment of inflammatory aortic abdominal aneurysm. Although our study included a small number of patients with endovascular aortic repair treatment, results are promising. Further randomized controlled studies may be necessary to assess long-term effectiveness of endovascular aortic repair treatment in this disease.
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Affiliation(s)
- África Duque Santos
- Department of Vascular and Endovascular Surgery, 16507 Ramón y Cajal´s University Hospital , Madrid, Spain
| | - Andrés Reyes Valdivia
- Department of Vascular and Endovascular Surgery, 16507 Ramón y Cajal´s University Hospital , Madrid, Spain
| | | | - Enrique Aracil Sanus
- Department of Vascular and Endovascular Surgery, 16507 Ramón y Cajal´s University Hospital , Madrid, Spain
| | - Julia Ocaña Guaita
- Department of Vascular and Endovascular Surgery, 16507 Ramón y Cajal´s University Hospital , Madrid, Spain
| | - Claudio Gandarias
- Department of Vascular and Endovascular Surgery, 16507 Ramón y Cajal´s University Hospital , Madrid, Spain
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Bouzas M, Tchana-Sato V, Lavigne JP. Infected abdominal aortic aneurysm due to Escherichia coli. Acta Chir Belg 2017; 117:200-202. [PMID: 27756195 DOI: 10.1080/00015458.2016.1242217] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Early diagnosis of infected abdominal aortic aneurysm (IAAA) is still a medical challenge due to its diverse and non-specific symptoms and signs. The most common responsible pathogens are Salmonella, Staphylococcus, Campylobacter and Streptococcus species. The authors report the case of a 67-year-old man, admitted for high fever and finally diagnosed with Escherichia coli (E.coli)-related IAAA. The IAAA ruptured during the general anaesthesia induction, leading to an emergency surgery. The authors successfully proceeded to an open aneurysmectomy with extensive debridement and in situ graft replacement. This case emphasizes the potential for rapid IAAA expansion, its high-rupture risk and the importance of computed tomography as a diagnostic tool.
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Affiliation(s)
- Miguel Bouzas
- Department of Vascular and Thoracic surgery, Regional Hospital of Huy, Belgium
| | - Vincent Tchana-Sato
- Department of Vascular and Thoracic surgery, Regional Hospital of Huy, Belgium
| | - Jean Paul Lavigne
- Department of Vascular and Thoracic surgery, Regional Hospital of Huy, Belgium
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Li Y, Li L, Zhang D, Wang X, Sun W, Wang H. A Contained Ruptured Abdominal Aortic Aneurysm Presenting with Vertebral Erosion. Ann Vasc Surg 2017; 41:279.e13-279.e17. [DOI: 10.1016/j.avsg.2016.09.025] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2016] [Revised: 09/07/2016] [Accepted: 09/09/2016] [Indexed: 11/25/2022]
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Romero Lozano M, Castejón Navarro B, Duque Santos A, Reyes Valdivia A, Ocaña Guaita J. Tratamiento quirúrgico de aneurisma micótico con preservación de injerto renal. ANGIOLOGIA 2017. [DOI: 10.1016/j.angio.2014.11.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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30
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Mavrogeni S, Markousis-Mavrogenis G, Kolovou G. IgG4-related cardiovascular disease. The emerging role of cardiovascular imaging. Eur J Radiol 2017; 86:169-175. [DOI: 10.1016/j.ejrad.2016.11.012] [Citation(s) in RCA: 44] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2016] [Revised: 10/06/2016] [Accepted: 11/06/2016] [Indexed: 12/24/2022]
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Nosoudi N, Chowdhury A, Siclari S, Karamched S, Parasaram V, Parrish J, Gerard P, Vyavahare N. Reversal of Vascular Calcification and Aneurysms in a Rat Model Using Dual Targeted Therapy with EDTA- and PGG-Loaded Nanoparticles. Am J Cancer Res 2016; 6:1975-1987. [PMID: 27698934 PMCID: PMC5039337 DOI: 10.7150/thno.16547] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2016] [Accepted: 07/28/2016] [Indexed: 02/06/2023] Open
Abstract
Degeneration of elastic lamina and vascular calcification are common features of vascular pathology such as aortic aneurysms. We tested whether dual therapy with targeted nanoparticles (NPs) can remove mineral deposits (by delivery of a chelating agent, ethylene diamine tetraacetic acid (EDTA)) and restore elastic lamina (by delivery of a polyphenol, pentagalloyl glucose (PGG)) to reverse moderate aneurysm development. EDTA followed by PGG NP delivery led to reduction in macrophage recruitment, matrix metalloproteinase (MMP) activity, elastin degradation and calcification in the aorta as compared to delivery of control blank NPs. Such dual therapy restored vascular elastic lamina and improved vascular function as observed by improvement in circumferential strain. Therefore, dual targeted therapy may be an attractive option to remove mineral deposits and restore healthy arterial structures in moderately developed aneurysms.
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Duque Santos A, Reyes Valdivia A, Miguel Morrondo A, Ocaña Guaita J. Actualización del diagnóstico y tratamiento de los aneurismas de aorta abdominal inflamatorios. ANGIOLOGIA 2016. [DOI: 10.1016/j.angio.2015.04.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Chimney-Graft as a Bail-Out Procedure for Endovascular Treatment of an Inflammatory Juxtarenal Abdominal Aortic Aneurysm. Case Rep Vasc Med 2015; 2015:531017. [PMID: 26064770 PMCID: PMC4443786 DOI: 10.1155/2015/531017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2015] [Revised: 04/26/2015] [Accepted: 04/30/2015] [Indexed: 11/23/2022] Open
Abstract
Inflammatory and
juxtarenal Abdominal Aortic Aneurysm (j-iAAA)
represents a technical challenge for open repair
(OR) due to the peculiar anatomy, extensive
perianeurysmal fibrosis, and dense adhesion to
the surrounding tissues. A 68-year-old man with
an 11 cm asymptomatic j-iAAA was
successfully treated with elective EVAR and
chimney-graft (ch-EVAR) without postprocedural complications. Target vessel patency
and normal renal function are present at 24-month follow-up. The treatment of j-iAAA can be
technically challenging. ch-EVAR is a feasible
and safe bail-out method for elective j-iAAA
with challenging anatomy.
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Liu S, Xu X, Ding X, Liu G, Zhao Z, Zhao X, Qin Y. Comparison of immediate results and mid-term follow-up of surgical and percutaneous closure of ruptured sinus of Valsalva aneurysm. J Cardiol 2014; 63:239-43. [DOI: 10.1016/j.jjcc.2013.08.011] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2013] [Revised: 08/12/2013] [Accepted: 08/20/2013] [Indexed: 11/15/2022]
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Appadurai V, Al-Hindawi A, Leschke P, Greaves K. Type A aortic dissection secondary to ruptured penetrating ascending aortic ulcer in an immunosuppressed patient. Heart Lung Circ 2014; 23:e139-41. [PMID: 24529504 DOI: 10.1016/j.hlc.2013.12.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2013] [Revised: 12/15/2013] [Accepted: 12/29/2013] [Indexed: 11/26/2022]
Affiliation(s)
- Vinesh Appadurai
- Department of Cardiology, Nambour General Hospital, Hospital Road, Nambour, Queensland 4560; School of Medicine, The University of Queensland, St Lucia, Queensland 4072.
| | - Ahmad Al-Hindawi
- Department of Radiology, Nambour General Hospital, Hospital Road, Nambour, Queensland 4560
| | - Paul Leschke
- Department of Radiology, Nambour General Hospital, Hospital Road, Nambour, Queensland 4560
| | - Kim Greaves
- Department of Cardiology, Nambour General Hospital, Hospital Road, Nambour, Queensland 4560; School of Medicine, The University of Queensland, St Lucia, Queensland 4072
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Affiliation(s)
- Miyu Tajima
- Department of Cardiovascular Medicine, Graduate School of Medicine, The University of Tokyo
- Department of Cardiology, Sakakibara Heart Institute
| | | | - Yukio Hiroi
- Department of Cardiology, National Center for Global Health and Medicine
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38
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Mleyhi S, Ghédira F, Ziadi J, Gara Ali B, Ben Gorbel I, Kaouel K, Ben Mrad M, Denguir R, Kalfat T, Khayati A. [Acute rupture of an abdominal aortic aneurysm revealing Takayasu arteritis]. ACTA ACUST UNITED AC 2013; 38:373-6. [PMID: 24210747 DOI: 10.1016/j.jmv.2013.09.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2013] [Accepted: 07/09/2013] [Indexed: 11/30/2022]
Abstract
Arterial aneurysms are most commonly (60% of cases) located in the infrarenal abdominal aorta. An inflammatory mechanism is involved in only 10% of cases. Infrarenal abdominal aortic aneurysms revealing Takayasu's disease is unusual. Takayasu's disease is a rare vasculitis affecting large arteries in young people. It is 10 times more common in women. We report the case of an acute rupture of an abdominal aortic aneurysm revealing Takayasu arteritis in a 39-year-old man with an uneventful medical history.
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Affiliation(s)
- S Mleyhi
- Service de chirurgie cardiovasculaire et thoracique, faculté de médecine de Tunis, université Tunis ELMANAR, CHU la Rabta, rue Jebbari, 1001 Tunis, Tunisie.
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39
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Fujita S, Nishioka N, Ito T, Wada Y, Kakita K, Ozawa H, Tsuji M, Katsumata T, Ishizaka N. Increased serum IgG4 levels and intimal IgG4-positive cell infiltration in rapidly growing aortic aneurysm. SAGE Open Med Case Rep 2013; 1:2050313X13496504. [PMID: 27489625 PMCID: PMC4857270 DOI: 10.1177/2050313x13496504] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
A 67-year-old Japanese man had been complaining of discomfort in the chest and back and feeling febrile for 2 weeks. Chest computed tomography indicated a thoracic aortic aneurysm. He occasionally showed a high fever (up to 38.0°C), even after hospital admission, irrespective of antibiotic therapy. The patient was found to have elevated serum IgG4 levels (366 mg/dL). The aneurysm demonstrated rapid growth; therefore, rifampicin-soaked woven Dacron synthetic graft replacement was performed 22 days after admission. Immunohistostatining of the resected aorta segment showed an IgG4-positive plasma cell infiltrate within the intimal layer neighboring the cholesterol-rich atheromatous plaque. After surgery, the patient’s serum IgG4 level dropped acutely; however, it did not reach the normal range. The possible role of IgG4 in the development or suppression of aortic remodeling, as well as in atherogenesis, among patients with rapidly growing aortic aneurysm requires further investigation.
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Affiliation(s)
- Shuichi Fujita
- Department of Cardiology, Osaka Medical College, Osaka, Japan
| | - Nobu Nishioka
- Department of Cardiology, Osaka Medical College, Osaka, Japan
| | - Takahide Ito
- Department of Cardiology, Osaka Medical College, Osaka, Japan
| | - Yuki Wada
- Department of Cardiology, Osaka Medical College, Osaka, Japan
| | - Ken Kakita
- Department of Cardiology, Osaka Medical College, Osaka, Japan
| | - Hideki Ozawa
- Department of Cardiovascular Surgery, Osaka Medical College, Osaka, Japan
| | - Motomu Tsuji
- Division of Pathology, Osaka Medical College, Osaka, Japan
| | - Takahiro Katsumata
- Department of Cardiovascular Surgery, Osaka Medical College, Osaka, Japan
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40
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Maruyama Y, Kitagawa N, Ito M, Yoshizaki T. A Case of Early Takayasu^|^apos;s Arteritis with Initial Symptoms of Carotidynia and Fever. ACTA ACUST UNITED AC 2013; 116:709-14. [DOI: 10.3950/jibiinkoka.116.709] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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41
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Yokoyama R, Tazaki R, Morita H, Nishitani H, Ariumi S, Osuga S, Sohmiya K, Kono T, Narumi Y, Tsuji M, Ishizaka N. Retroperitoneal fibrosis in a patient with gastric cancer manifested by lower extremity edema and hydrocele. Intern Med 2012; 51:2157-60. [PMID: 22892495 DOI: 10.2169/internalmedicine.51.7660] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Herein we report a 57-year-old man with lower extremity edema and swelling in the scrotum who was found to have a periaortic soft tissue mass and hydronephrosis by computed tomography. With the most plausible diagnosis of retroperitoneal fibrosis, corticosteroid therapy was initiated; however, it did not improve his symptoms. Upper gastroscopy performed on day 20 post admission showed ulcerative regions with an irregular border and fusion of thickened rugae at the gastric angle; the diagnosis of gastric adenocarcinoma was confirmed histologically. It is important to always be aware of unrecognized malignancies that are accompanied by retroperitoneal fibrosis.
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Affiliation(s)
- Ryo Yokoyama
- Department of Cardiology, Osaka Medical College, Japan
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