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Winston J, Lovelock T, Kelly T, Vasudevan T. A Case of Successful Endovascular Aortic Repair of Primary Aortoenteric Fistula Without Aortic Explantation. J Endovasc Ther 2022; 29:962-965. [PMID: 34986704 DOI: 10.1177/15266028211067734] [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: 11/16/2022]
Abstract
PURPOSE The objective of this study is to report a case of a primary aortoenteric fistula successfully treated with endovascular repair without aortic explant. CASE REPORT A 48-year-old man presented with a 24-hour history of hematemesis and malena. A computed tomography (CT) abdomen and pelvis demonstrated a 6 cm infrarenal aortic aneurysm with periaortic stranding and contrast enhancement within the lumen of the third part of the duodenum. The patient underwent emergency Endovascular Aortic Repair (EVAR). The patient was discharged on day 8 of his admission on oral antibiotics. He returned 7 weeks postindex procedure and underwent a laparotomy with omental patch repair of the aortic defect. Intraoperative cultures grew candida albicans, and the patient was discharged on lifelong oral Fluconazole and Amoxycillin-Clavulanic Acid. At 18 months postoperatively, the patient was clinically stable with improved appearances on CT aortogram. CONCLUSION We discuss the use of EVAR without aortic explant as a possible treatment option in the management of patient with primary aortoenteric fistulae. This may potentially avoid the significant morbidity and mortality associated with aortic explant in suitable candidates without perioperative signs of sepsis.
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Affiliation(s)
- Joshua Winston
- Department of Vascular Surgery, The Alfred Hospital, Melbourne, Victoria, Australia
| | - Thomas Lovelock
- Department of Vascular Surgery, The Alfred Hospital, Melbourne, Victoria, Australia
| | - Thomas Kelly
- Department of Vascular Surgery, The Alfred Hospital, Melbourne, Victoria, Australia
| | - Thodur Vasudevan
- Department of Vascular Surgery, The Alfred Hospital, Melbourne, Victoria, Australia
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2
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Noda K, Yokawa K, Dan N, Matsuda H. Endovascular and Endoscopic Treatment for Primary Aortoduodenal Fistula: A Case Report. Ann Vasc Dis 2022; 15:154-156. [PMID: 35860827 PMCID: PMC9257393 DOI: 10.3400/avd.cr.22-00015] [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: 01/20/2022] [Accepted: 04/12/2022] [Indexed: 11/19/2022] Open
Abstract
Primary aortoduodenal fistula (ADF) is a relatively rare and morbid diagnosis. A 91-year-old man who developed hematemesis and melena was transferred from a community hospital with the diagnosis of a ruptured abdominal aortic aneurysm (AAA). Computed tomography revealed an irregular-shaped AAA with cavities enhanced near the duodenum, with suspected ADF. The patient was initially treated with emergency endovascular aneurysm repair. Duodenoscopy showed defects of the mucosa. ADF was diagnosed, and fistulas were closed with endoscopic clipping. This case highlights the success of ADF endovascular repair.
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Affiliation(s)
- Kazuki Noda
- Department of Cardiovascular Surgery, National Cerebral and Cardiovascular Center
| | - Koki Yokawa
- Department of Cardiovascular Surgery, National Cerebral and Cardiovascular Center
| | - Naoki Dan
- Department of Gastroenterology, Suita Municipal Hospital
| | - Hitoshi Matsuda
- Department of Cardiovascular Surgery, National Cerebral and Cardiovascular Center
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3
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Miki T, Ohki S, Yasuhara K, Obayashi T. Endovascular aortic repair of mycotic abdominal aortic aneurysm with multiple systemic abscesses. INDIAN JOURNAL OF VASCULAR AND ENDOVASCULAR SURGERY 2022. [DOI: 10.4103/ijves.ijves_91_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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4
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Linn YL, Ng NZP, Tang TY, Chong TT. Endoleak Complicated by communicating psoas abscess and aorto-enteric fistula in an immunocompromised patient. Ann Vasc Surg 2021; 78:378.e23-378.e29. [PMID: 34487807 DOI: 10.1016/j.avsg.2021.06.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2021] [Revised: 06/24/2021] [Accepted: 06/24/2021] [Indexed: 11/16/2022]
Abstract
PURPOSE While endovascular repair of aortic aneurysm (EVAR) has become the mainstay treatment for abdominal aortic aneurysm (AAA), it is not without its disadvantages. Feared complications include graft infections, fistulation and endoleak, the outcomes of which may be life limiting. CASE REPORT We present a case of a 57 year-old patient with human immunodeficiency virus (HIV) previously treated with EVAR for AAA complicated by endoleak post treatment. He developed an aorto-psoas abscess 2 years later which harboured Mycobacterium avium complex, and medical therapy was unsuccessful. He eventually underwent an extra-anatomical bypass and graft explant, for which an aortoenteric fistula was also discovered and repaired. CONCLUSION Infection of endografts post EVAR is relatively rare, and there are presently no guidelines concerning its management. The concomittance of aorto-psoas abscess and aortoenteric fistula is even more uncommon, and necessitated surgical explant for source control purposes in our patient. Lifelong surveillance is required for complications of the aortic stump and bypass patency.
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Affiliation(s)
- Yun Le Linn
- Department of Vascular Surgery, Singapore General Hospital, Singapore.
| | - Nick Zhi Peng Ng
- Department of Vascular Surgery, Singapore General Hospital, Singapore
| | - Tjun Yip Tang
- Department of Vascular Surgery, Singapore General Hospital, Singapore
| | - Tze Tec Chong
- Department of Vascular Surgery, Singapore General Hospital, Singapore
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5
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de Donato G, Pasqui E, Panzano C, Brancaccio B, Grottola G, Galzerano G, Benevento D, Palasciano G. The Polymer-Based Technology in the Endovascular Treatment of Abdominal Aortic Aneurysms. Polymers (Basel) 2021; 13:1196. [PMID: 33917214 PMCID: PMC8068055 DOI: 10.3390/polym13081196] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Revised: 04/02/2021] [Accepted: 04/04/2021] [Indexed: 12/18/2022] Open
Abstract
An abdominal aortic aneurysm (AAA) is a dilatation of the abdominal aorta that progressively grows until it ruptures. Treatment is typically recommended when the diameter is more than 5 cm. The EVAR (Endovascular aneurysm repair) is a minimally invasive procedure that involves the placement of an expandable stent graft within the aorta to treat aortic disease without operating directly on the aorta. For years, stent grafts' essential design was based on metallic stent frames to support the fabric. More recently, a polymer-based technology has been proposed as an alternative method to seal AAA. This review underlines the two platforms that are based on a polymer technology: (1) the polymer-filled endobags, also known as Endovascular Aneurysm Sealing (EVAS) with Nellix stent graft; and (2) the O-ring EVAR polymer-based proximal neck sealing device, also known as an Ovation stent graft. Polymer characteristics for this particular aim, clinical applications, and durability results are hereby summarized and commented critically. The technique of inflating endobags filled with polymer to exclude the aneurysmal sac was not successful due to the lack of an adequate proximal fixation. The platform that used polymer to create a circumferential sealing of the aneurysmal neck has proven safe and effective.
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Affiliation(s)
- Gianmarco de Donato
- Department of Vascular Surgery, University of Siena, 53100 Siena, Italy; (E.P.); (C.P.); (B.B.); (G.G.); (G.G.); (D.B.); (G.P.)
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6
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Upchurch GR, Escobar GA, Azizzadeh A, Beck AW, Conrad MF, Matsumura JS, Murad MH, Perry RJ, Singh MJ, Veeraswamy RK, Wang GJ. Society for Vascular Surgery clinical practice guidelines of thoracic endovascular aortic repair for descending thoracic aortic aneurysms. J Vasc Surg 2021; 73:55S-83S. [DOI: 10.1016/j.jvs.2020.05.076] [Citation(s) in RCA: 46] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Accepted: 05/29/2020] [Indexed: 12/17/2022]
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7
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A successful staged approach for treatment of concomitant mitral insufficiency and mycotic aneurysm. JTCVS Tech 2020; 1:6-8. [PMID: 34346926 PMCID: PMC8288813 DOI: 10.1016/j.xjtc.2019.11.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2019] [Revised: 10/28/2019] [Accepted: 11/29/2019] [Indexed: 11/25/2022] Open
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8
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Della Schiava N, Arsicot M, Montveneur M, Millon A. Successful total endovascular repair of a giant salmonella-infected painful thoraco-abdominal aortic pseudoaneurysm. Interact Cardiovasc Thorac Surg 2018; 27:792-793. [PMID: 29757367 DOI: 10.1093/icvts/ivy142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2018] [Accepted: 03/27/2018] [Indexed: 11/13/2022] Open
Abstract
Endovascular approach is now a safe and effective technique for the elective treatment of a thoraco-abdominal aneurysm. This technique has significantly reduced the morbi-mortality for elective surgery. Moreover, it can permit to treat patients with a high surgical risk who are not eligible for open surgery. The permanent availability of endovascular material opens the door for treating a complex emergency thoraco-abdominal aneurysm. Here, we present the case of an 81-year-old man who had a rapidly evolving salmonella-infected aortic thoraco-abdominal Type IV pseudoaneurysm. Total endovascular treatment using aortic endoprosthesis, chimneys for coeliac trunk and superior mesenteric artery and periscopes for renal arteries was performed and permitted to obtain the complete exclusion of the pseudoaneurysm. The patient was event free and discharged from hospital after a few days with an antibiotic treatment adapted for salmonella. He was still event free 10 months after surgery. Endovascular technique might be a viable option even for an emergency infected complex thoraco-abdominal aortic aneurysm. Secondary open surgery should be discussed under the benefit-risk balance.
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Affiliation(s)
- Nellie Della Schiava
- Department of Vascular and Endovascular Surgery, Hospices civils de Lyon, Lyon, France
| | - Matthieu Arsicot
- Department of Vascular and Endovascular Surgery, Hospices civils de Lyon, Lyon, France
| | - Mathias Montveneur
- Department of Vascular and Endovascular Surgery, University Hospital of Saint Etienne, Saint Etienne, France
| | - Antoine Millon
- Department of Vascular and Endovascular Surgery, Hospices civils de Lyon, Lyon, France.,Claude Bernard Lyon 1 University, Lyon, France
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9
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Streptococcus pyogenes Pericarditis with Resultant Pulmonary Trunk Compression Secondary to Mycotic Pseudoaneurysm. Case Rep Cardiol 2018; 2018:3514797. [PMID: 30186637 PMCID: PMC6116405 DOI: 10.1155/2018/3514797] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2018] [Accepted: 06/23/2018] [Indexed: 12/20/2022] Open
Abstract
Purulent pericarditis is a rare disease in the era of antibiotics, with Streptococcus pyogenes being a possible, though uncommon etiology. Even more uncommon are mycotic aneurysms secondary to group A strep purulent pericarditis and bacteremia. We report a case of an 18-year-old female with a history of strep pharyngitis develop Streptococcus pyogenes purulent pericarditis with subsequent ventricular fibrillation (VF). Following initial stabilization, she ultimately developed a 4.8 cm mycotic aneurysm of the ascending aorta, with resultant compression of the pulmonary trunk and right pulmonary arteries.
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10
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Li HL, Chan YC, Cheng SW. Current Evidence on Management of Aortic Stent-graft Infection: A Systematic Review and Meta-Analysis. Ann Vasc Surg 2018; 51:306-313. [PMID: 29772328 DOI: 10.1016/j.avsg.2018.02.038] [Citation(s) in RCA: 54] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2017] [Revised: 08/26/2017] [Accepted: 02/19/2018] [Indexed: 11/28/2022]
Abstract
BACKGROUND Aortic stent-graft infection (SGI) is rare but remains one of the most challenging and threatening complications. This systematic review aimed to identify the clinical features, treatment, and outcomes of endograft infection after abdominal endovascular aortic repair (EVAR) and thoracic endovascular aortic repair (TEVAR). METHODS A systematic literature review of all published literature from January 1991 to September 2016 on SGI was performed under the instruction of Preferred Reporting Items for Systematic Reviews and Meta-Analyses. Aorta, aneurysm, endovascular, stent-graft, endograft and infection were the keywords used in our comprehensive search in PubMed and MEDLINE databases. Data analysis was performed using SPSS, V 22.0. RESULTS A total of 185 potential relevant articles were identified, but only 11 studies with 402 patients met the inclusion criteria. Majority of the patients were male (308/402, 77%), with a mean age ranging from 65 to 73 years. Most of the endografts were implanted for EVAR (351/402, 87%), while the other 51 (13%) endografts were infected following TEVAR. Among the 402 patients, 39 (9.7%) patients presented with aortic rupture. Ninety-two of 380 (24.2%) patients with available data had aortoenteric fistula (AEF). Sixty-nine patients (17%) died in hospital or within 30 days after operation. One hundred fourteen patients (28%) died during follow-up. The most commonly used stent grafts were Zenith (Cook Inc, Bloomington, IN) (22%) and Excluder (W.L. Gore, Flagstaff, AZ) (20%). Of the 402 patients in this series, 108 patients (27%) had negative culture, and multiple microorganisms were identified in 103 patients (26%). The most frequently isolated microorganisms were Staphylcoccus species (30.1%), Streptococcus (14.8%), and fungus (9.2%). Forty-two patients (42/401, 10%) received conservative treatment, whereas 359 (90%) patients underwent surgical treatment, including stent graft removal with in situ reconstruction or extra-anatomical bypass, and secondary endovascular procedure. Patients in the surgical group had a higher survival rate compared with conservative group (58% vs. 33%, P = 0.002). The survival rate was higher in the patients with infected EVAR than TEVAR (58% vs. 27%, P = 0.000). Patient with AEF had a worse prognosis (survival rate 72% vs. 33%, P = 0.002). CONCLUSIONS Current evidence suggests that surgical treatment is a better option compared with conservative management in selected patients with aortic endograft infection. The outcome was worse in patients with infected TEVAR and AEF.
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Affiliation(s)
- Hai Lei Li
- Division of Vascular Surgery, Department of Surgery, University of Hong Kong Shenzhen hospital, Guangdong, China
| | - Yiu Che Chan
- Division of Vascular & Endovascular Surgery, Department of Surgery, University of Hong Kong Medical Centre, South Wing, 14th Floor K Block, Queen Mary Hospital, Hong Kong, China.
| | - Stephen W Cheng
- Division of Vascular & Endovascular Surgery, Department of Surgery, University of Hong Kong Medical Centre, South Wing, 14th Floor K Block, Queen Mary Hospital, Hong Kong, China
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11
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Jun H, Jung CW. Immunoglobulin G4-Related Inflammatory Abdominal Aortic Aneurysm Associated With Myasthenia Gravis, With Contained Rupture. Vasc Endovascular Surg 2017; 50:571-574. [DOI: 10.1177/1538574416678557] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Immunoglobulin (Ig) G4-related disease is reportedly among the various causes of inflammatory abdominal aortic aneurysm (IAAA). Many IgG4-related diseases are closely related to allergic constitution and autoimmune disease. We report a case of a 72-year-old man with IgG4-related IAAA associated with myasthenia gravis, with contained rupture.
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Affiliation(s)
- Heungman Jun
- Department of Surgery, Korea University Anam Hospital, Seoul, Korea
| | - Cheol Woong Jung
- Department of Surgery, Korea University Anam Hospital, Seoul, Korea
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12
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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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13
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Chiu PW, Pan ST, Hsu CC, Chen KT. Age Is Not a Relative Contraindication for Surgical Treatment of Infected Aortic and Iliac Aneurysms. J Am Geriatr Soc 2016; 64:e310-e311. [PMID: 27996113 DOI: 10.1111/jgs.14396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Po-Wei Chiu
- Emergency Department, Chi-Mei Medical Center, Tainan, Taiwan
| | - Shih-Tien Pan
- Emergency Department, Chi-Mei Medical Center, Tainan, Taiwan
| | - Chien-Chin Hsu
- Emergency Department, Chi-Mei Medical Center, Tainan, Taiwan.,Department of Biotechnology, Southern Tainan University of Technology, Tainan, Taiwan
| | - Kuo-Tai Chen
- Emergency Department, Chi-Mei Medical Center, Tainan, Taiwan.,Department of Emergency Medicine, Taipei Medical University, Taipei, Taiwan
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14
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Wilson WR, Bower TC, Creager MA, Amin-Hanjani S, O’Gara PT, Lockhart PB, Darouiche RO, Ramlawi B, Derdeyn CP, Bolger AF, Levison ME, Taubert KA, Baltimore RS, Baddour LM. Vascular Graft Infections, Mycotic Aneurysms, and Endovascular Infections: A Scientific Statement From the American Heart Association. Circulation 2016; 134:e412-e460. [DOI: 10.1161/cir.0000000000000457] [Citation(s) in RCA: 215] [Impact Index Per Article: 26.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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15
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Yamamoto Y, Igari K, Toyofuku T, Kudo T, Inoue Y. Late Stent Graft Infection after the Emergency Endovascular Repair of a Secondary Iliac Artery-Enteric Fistula Treated with Graft Removal and In Situ Aortic Reconstruction Using Femoral Veins. Ann Thorac Cardiovasc Surg 2016; 23:113-117. [PMID: 27396381 DOI: 10.5761/atcs.cr.16-00132] [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] [Indexed: 12/17/2022] Open
Abstract
An arterioenteric fistula is a devastating and life-threatening condition that requires urgent treatment. Less-invasive endovascular treatment has emerged as an alternative to conventional open repair, but postoperative graft infection remains a major concern. We herein report a case of late stent graft infection after emergency endovascular repair of a secondary iliac artery-enteric fistula. The patient was a 63-year-old male who presented with a fever, who had undergone successful endovascular stent grafting for a secondary common iliac artery-enteric fistula 29 months prior. The diagnosis of a stent graft infection was confirmed via computed tomography. He underwent graft removal and in situ reconstruction with femoral vein grafts. At 6-month follow-up, the patient is in a good general condition without any symptoms.
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Affiliation(s)
- Yohei Yamamoto
- Division of Vascular and Endovascular Surgery, Department of Surgery, Tokyo Medical and Dental University, Tokyo, Japan
| | - Kimihiro Igari
- Division of Vascular and Endovascular Surgery, Department of Surgery, Tokyo Medical and Dental University, Tokyo, Japan
| | - Takahiro Toyofuku
- Division of Vascular and Endovascular Surgery, Department of Surgery, Tokyo Medical and Dental University, Tokyo, Japan
| | - Toshifumi Kudo
- Division of Vascular and Endovascular Surgery, Department of Surgery, Tokyo Medical and Dental University, Tokyo, Japan
| | - Yoshinori Inoue
- Division of Vascular and Endovascular Surgery, Department of Surgery, Tokyo Medical and Dental University, Tokyo, Japan
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16
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Successful Endovascular Repair of a Penetrating Aortic Ulcer in Bacterial Aortitis. Ann Vasc Surg 2016; 35:205.e13-7. [PMID: 27236095 DOI: 10.1016/j.avsg.2016.01.030] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2015] [Revised: 01/07/2016] [Accepted: 01/09/2016] [Indexed: 11/23/2022]
Abstract
Infective aortitis (IA) and penetrating aortic ulcer (PAU) impending for rupture represent 2 hostile life-threatening conditions. Simultaneous presentations of these rare entities can be considered an exception. The pleomorphic clinical presentation and the multifactorial etiology require a multidisciplinary approach to reach a correct diagnosis and an urgent treatment. We report the case of a 65-year-old patient presented with acute abdominal pain and septic shock secondary to a bacterial aortitis and penetrating ulcer of abdominal aorta. Unfit for surgery due to severe comorbidities, he was treated by means of a tubular endograft and long-term antibiotic therapy. A rapid improvement of clinical conditions was observed during the subsequent hospital stay. Complete regression of aortic involvement was demonstrated after 1 year. In conclusion, for selected patients affected by IA and PAU an endovascular approach associated to long-term antibiotic therapy may be safe and effective.
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17
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Voulalas G, Makris S, Papacharalampous G, Maltezos C. Mycotic Aneurysm Due to Leclercia Adecarboxylata: A Complication of Vertebral Osteomyelitis. Ann Vasc Surg 2016; 33:229.e1-5. [DOI: 10.1016/j.avsg.2015.11.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2015] [Revised: 09/14/2015] [Accepted: 11/08/2015] [Indexed: 12/12/2022]
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19
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Alioti MHFDA, Alioti R, Faria RCSD, Camargo Júnior OD, Geiger MA. Aneurisma de aorta abdominal infectado por Salmonella species. J Vasc Bras 2016. [DOI: 10.1590/1677-5449.004415] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Resumo Os aneurismas de aorta abdominal infecciosos (AAAIs) são raros e apresentam uma alta mortalidade devido à septicemia e ao risco de ruptura. A opção terapêutica consagrada consiste na correção aberta com ressecção do aneurisma, debridamento e reconstrução com veia autóloga. Mais recentemente, alguns grupos vêm relatando séries de casos nas quais se realizou tratamento endovascular. Em ambas as opções, a antibioticoterapia adjuvante é imperativa. Relatamos um caso ilustrativo em que o tratamento de escolha foi a cirurgia aberta com reconstrução utilizando-se veia autóloga.
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20
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Use of Aortic Occluders and Endovascular Plugs in a 2-step Hybrid Treatment of Secondary Aortoenteric Fistulas. Ann Vasc Surg 2015; 30:310.e9-15. [PMID: 26522586 DOI: 10.1016/j.avsg.2015.07.034] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2015] [Revised: 07/14/2015] [Accepted: 07/20/2015] [Indexed: 11/24/2022]
Abstract
Aortoenteric fistula (AEF) is a dreadful complication of abdominal aortic surgery. Surgical treatment is associated to high mortality and requires urgent graft removal with extra-anatomic or in situ reconstruction. Other authors suggest the use of stent grafts, both as a stand-alone procedure or as a bridge solution before open repair. We reviewed the results of a cohort of patients that presented at our institution with an AEF and were treated with a novel 2-step endovascular-open surgical procedure. The first step consisted in immediate endovascular occlusion of the infrarenal graft with deployment, below the renal arteries, of an aortic occluder and/or endovascular plugs. After occlusion of the infrarenal graft, extra-anatomic reconstruction (axillofemoral bypass) was performed. The second step consisted in the removal of the infrarenal graft with aortic stump ligation and took place after a few days recovery to allow improvement of patients' condition. A total of 5 selected patients were treated. Endovascular aortic occlusion was achieved in all cases with the deployment of 1 (3 patients) or 2 (2 patients) devices. The mean interval between the first and the second step was 7 days (min 4-max 13). Complete removal of the aortic graft was possible in all patients. One patient died on the first postoperative day due to multiorgan failure (1 of 5, 20%). Mean survival after discharge was 24 months (min 6-max 36). One patient died at 6 months because of aortic stump blowout. In our initial experience, endovascular aortic occlusion seems an effective option to prevent fatal enteric bleeding and a valuable first-step treatment for selected cases of AEF.
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21
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Davila VJ, Stone W, Duncan AA, Wood E, Jordan WD, Zea N, Sternbergh WC, Money SR. A multicenter experience with the surgical treatment of infected abdominal aortic endografts. J Vasc Surg 2015; 62:877-83. [DOI: 10.1016/j.jvs.2015.04.440] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2015] [Accepted: 04/23/2015] [Indexed: 11/29/2022]
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22
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Varetto G, Gibello L, Trevisan A, Castagno C, Garneri P, Rispoli P. Primary Aortoenteric Fistula of a Saccular Aneurysm: Case Study and Literature Review. Korean Circ J 2015; 45:337-9. [PMID: 26240589 PMCID: PMC4521113 DOI: 10.4070/kcj.2015.45.4.337] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2014] [Revised: 05/05/2014] [Accepted: 06/25/2015] [Indexed: 02/05/2023] Open
Abstract
Primary aortoenteric fistula is a direct communication between the aorta and intestinal lumen and it represents a rare but potentially lethal complication of an abdominal aortic aneurysm. However, it may occur less frequently in a naive non-aneurysmatic aorta. Diagnosis is often difficult and delayed in most cases, unless there is a high level of clinical awareness. Urgent surgery is still the recommended treatment. We describe the case of primary aortoenteric fistula of a saccular aneurysm. A 55-year-old woman was referred to our center with hematemesis, melena, and severe anemia who was dignosed previously with unknown saccular abdominal aneurysm.
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Affiliation(s)
- Gianfranco Varetto
- Division of Vascular Surgery, Department of Surgical Sciences, AOU Città della Salute e della Scienza, Torino, Italy
| | - Lorenzo Gibello
- Division of Vascular Surgery, Department of Surgical Sciences, AOU Città della Salute e della Scienza, Torino, Italy
| | - Alessandra Trevisan
- Division of Vascular Surgery, Department of Surgical Sciences, AOU Città della Salute e della Scienza, Torino, Italy
| | - Claudio Castagno
- Division of Vascular Surgery, Department of Surgical Sciences, AOU Città della Salute e della Scienza, Torino, Italy
| | - Paolo Garneri
- Division of Vascular Surgery, Department of Surgical Sciences, AOU Città della Salute e della Scienza, Torino, Italy
| | - Pietro Rispoli
- Division of Vascular Surgery, Department of Surgical Sciences, AOU Città della Salute e della Scienza, Torino, Italy
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Setacci C, Chisci E, Setacci F, Ercolini L, de Donato G, Troisi N, Galzerano G, Michelagnoli S. How To Diagnose and Manage Infected Endografts after Endovascular Aneurysm Repair. AORTA : OFFICIAL JOURNAL OF THE AORTIC INSTITUTE AT YALE-NEW HAVEN HOSPITAL 2014; 2:255-64. [PMID: 26798744 DOI: 10.12945/j.aorta.2014.14-036] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/16/2014] [Accepted: 10/03/2014] [Indexed: 12/14/2022]
Abstract
The prevalence of endograft infections (EI) after endovascular abdominal aortic aneurysm repair is below 1%. With the growing number of patients with aortic endografts and the aging population, the number of patients with EI might also increase. The diagnosis is based on an association of clinical symptoms, imaging, and microbial cultures. Angio-computed tomography is currently the gold-standard technique for diagnosis. Low-grade infection sometimes requires nuclear medicine imaging to make a correct diagnosis. There is no good evidence to guide management so far. In the case of active gastrointestinal bleeding, pseudoaneurysm, or extensive perigraft purulence involving adjacent organs, an invasive treatment should always be attempted. In the other cases (the majority), when there is not an immediate danger to the patient's life, a conservative management is started with a proper antimicrobial therapy. Any infectious cavity can be percutaneously drained. Management depends on the patient's condition and a tailored approach should always be offered. In the case of a patient who is young, has a good life expectancy, or in whom there is absence of significant comorbidities, a surgical attempt can be proposed. Surgical techniques favor, in terms of mortality, patency, and reinfection rate, the in situ reconstruction. Choice of technique relies on the center and the operator's experience. Long-term antibiotic therapy is always required in all cases, with close monitoring of the C-reactive protein.
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Affiliation(s)
- Carlo Setacci
- Vascular and Endovascular Surgery Unit, University of Siena, Siena, Italy
| | - Emiliano Chisci
- Department of Surgery, Vascular and Endovascular Surgery Unit, "San Giovanni di Dio" Hospital, Florence, Italy; and
| | - Francesco Setacci
- P. Valdoni Department of Surgery, La Sapienza University, Rome, Italy
| | - Leonardo Ercolini
- Department of Surgery, Vascular and Endovascular Surgery Unit, "San Giovanni di Dio" Hospital, Florence, Italy; and
| | | | - Nicola Troisi
- Department of Surgery, Vascular and Endovascular Surgery Unit, "San Giovanni di Dio" Hospital, Florence, Italy; and
| | - Giuseppe Galzerano
- Vascular and Endovascular Surgery Unit, University of Siena, Siena, Italy
| | - Stefano Michelagnoli
- Department of Surgery, Vascular and Endovascular Surgery Unit, "San Giovanni di Dio" Hospital, Florence, Italy; and
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Gardiner BJ, Wong J, Yii M, Buckenham T, Korman TM. Streptococcus pyogenes aortic aneurysm infection: forgotten but not gone. Infect Dis Rep 2013; 5:e11. [PMID: 24470961 PMCID: PMC3892607 DOI: 10.4081/idr.2013.e11] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2013] [Revised: 08/07/2013] [Accepted: 08/07/2013] [Indexed: 11/24/2022] Open
Abstract
Historically, Streptococcus pyogenes was a common cause of endocarditis and infected aortic aneurysm. Today, endovascular infections due to this organism have become exceedingly rare. We report the first case of aortic aneurysm infection due to S. pyogenes treated with initial endoluminal repair, review previous reports and discuss current treatment options.
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Affiliation(s)
| | - Joy Wong
- Department of Vascular Surgery and , Clayton, Victoria
| | - Ming Yii
- Department of Vascular Surgery and , Clayton, Victoria
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25
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Perera AH, Kashef E, Gibbs RGJ. Staged open, endovascular, and hybrid repair of concomitant mycotic aneurysms. Ann Vasc Surg 2013; 28:1031.e7-1031.e10. [PMID: 24184462 DOI: 10.1016/j.avsg.2013.07.022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2013] [Revised: 07/03/2013] [Accepted: 07/10/2013] [Indexed: 10/26/2022]
Abstract
Primary mycotic aneurysms of the aorta are a rare but life-threatening condition. A 59-year-old woman developed a back abscess secondary to an insect bite. A computed tomography scan revealed 3 concomitant mycotic aneurysms, including a rupture. Staged repair was undertaken: immediate open repair for contained rupture of a type IV thoracoabdominal aortic aneurysm, followed by endovascular repair of a descending thoracic aneurysm 3 weeks later and finally an aortic arch hybrid repair of a left subclavian artery aneurysm 16 months later. She remains well postoperatively. There is currently no consensus on the timing of repair or modality of treatment of mycotic aneurysms. Each patient should be treated individually based on aneurysm location, rupture, and comorbidities, as shown by this case.
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Affiliation(s)
- Anisha H Perera
- Imperial Vascular Unit, St. Mary's Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - Elika Kashef
- Department of Interventional Radiology, St. Mary's Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - Richard G J Gibbs
- Imperial Vascular Unit, St. Mary's Hospital, Imperial College Healthcare NHS Trust, London, UK.
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26
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Lyons O, Patel A, Saha P, Clough R, Price N, Taylor P. A 14-year Experience with Aortic Endograft Infection: Management and Results. Eur J Vasc Endovasc Surg 2013; 46:306-13. [DOI: 10.1016/j.ejvs.2013.04.021] [Citation(s) in RCA: 62] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2013] [Accepted: 04/10/2013] [Indexed: 02/05/2023]
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27
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Tratamiento endovascular de aneurismas infecciosos. ANGIOLOGIA 2013. [DOI: 10.1016/s0003-3170(13)70081-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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