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Cox K, Sundaram RD, Popescu M, Pillai K, Kermali M, Harky A. A review on the deeper understanding of inflammation and infection of the thoracic aorta. Vascular 2023; 31:257-265. [PMID: 35469491 PMCID: PMC10021126 DOI: 10.1177/17085381211060928] [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: 11/17/2022]
Abstract
OBJECTIVE To review the current literature regarding infection and inflammation of the thoracic aorta and to summarise its aetiologies, pathogenesis and clinical presentation. Additionally, the authors sought to compare diagnostic methods and to analyse the different management options. METHOD A comprehensive electronic search using PubMed, MEDLINE, Scopus and Google Scholar was conducted to find relevant journal articles with key search terms including: 'aortitis', 'thoracic aortic infection' and 'surgical management of infected thoracic aortic aneurysms'. Prominent publications from 1995 till present (2021) were analysed to achieve a deeper understanding of thoracic aorta infection and inflammation, and the information was then collated to form this review. RESULTS The literature review revealed that infectious causes are more prominent than non-infectious causes, with Gram positive bacteria such as Staphylococcus, Enterococcus and Streptococcus accounting for approximately 60% of the infections. The authors also noted that Staphylococcus Aureus was associated with poorer outcomes. Key diagnostic tools include MRI and multi-slice CT imaging, which are useful imaging modalities in defining the extent of the disease thus allowing for planning surgical intervention. Surgical intervention itself is extremely multifaceted and the rarity of the condition means no large-scale comparative research between all the management options exists. Until more large-scale comparative data becomes available to guide treatment, the optimal approach must be decided on a case-by-case basis, considering the benefits and drawback of each treatment option. CONCLUSION A high index of suspicion and a comprehensive history is required to effectively diagnose and manage infection and inflammation of the thoracic aorta. Differentiating between infectious and inflammatory cases is crucial for management planning, as infectious causes typically require antibiotics and surgical intervention. Over the years, the post treatment results have shown significant improvement due to earlier diagnosis, advancement in surgical options and increasingly specific microbial therapy.
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Affiliation(s)
- Kofi Cox
- Faculty of Medicine, RinggoldID:4915St George's Hospital Medical School, University of London, London, UK
| | | | - Mara Popescu
- Faculty of Medicine, RinggoldID:405987King's College London, London, UK
| | - Kiran Pillai
- Faculty of Medicine, RinggoldID:4915St George's Hospital Medical School, University of London, London, UK
| | - Muhammed Kermali
- Faculty of Medicine, RinggoldID:4915St George's Hospital Medical School, University of London, London, UK
| | - Amer Harky
- Department of Cardiothoracic Surgery, RinggoldID:156669Liverpool Heart and Chest Hospital, Chester, UK
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2
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Lim YT, Tay WM, Lo ZJ, Pua U, Quek LHH, Tan BP, Chandrasekar S, Tan GWL. Endovascular repair of mycotic aortic aneurysms confers good medium-term outcomes and aneurysmal sac resolution. Singapore Med J 2022; 63:263-267. [PMID: 36043296 PMCID: PMC9297181 DOI: 10.11622/smedj.2020165] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
INTRODUCTION Mycotic aortic aneurysm (MAA) is a life-threatening condition. Endovascular repair (EVAR) of aortic aneurysms has been found to be a safe and effective alternative to open repair. We aimed to present the short- to medium-term outcomes for EVAR of MAA in our cohort. METHODS We conducted a retrospective study of 23 consecutive patients with MAA who underwent EVAR in our hospital from January 2008 to July 2017. RESULTS The mean age of our study population was 62 years. The mean aneurysmal size was 3.2 cm. Abdominal MAAs (n = 16, 70%) were the most common, followed by thoracic MAAs (n = 4, 17%). There was no 30-day mortality in our cohort. Endoleak (Types 1, 3, 4) was detected in 3 (13%) cases. At the one-month surveillance computed tomography aortogram, all patients had a reduction in aneurysmal size and 5 (22%) had complete aneurysmal sac resolution. 7 (30%) patients had sac resolution at six months and 8 (35%) patients, at 12 months. The overall survival was 91%, 80% and 61% at one, 12 and 60 months, respectively. CONCLUSION EVAR is a feasible and durable method for the repair of MAA, with a five-year overall survival of 61%. All patients in our study had a reduction in aneurysmal size at one month, with 65% having complete aneurysmal sac resolution by 12 months.
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Affiliation(s)
- Yi Ting Lim
- Vascular Surgery Service, Department of General Surgery, Tan Tock Seng Hospital, Singapore
| | - Wee Ming Tay
- Vascular Surgery Service, Department of General Surgery, Tan Tock Seng Hospital, Singapore
| | - Zhiwen Joseph Lo
- Vascular Surgery Service, Department of General Surgery, Tan Tock Seng Hospital, Singapore
| | - Uei Pua
- Vascular and Interventional Radiology, Department of Diagnostic Radiology, Tan Tock Seng Hospital, Singapore
| | - Lawrence Han Hwee Quek
- Vascular and Interventional Radiology, Department of Diagnostic Radiology, Tan Tock Seng Hospital, Singapore
| | - Bien Ping Tan
- Vascular and Interventional Radiology, Department of Diagnostic Radiology, Tan Tock Seng Hospital, Singapore
| | - Sadhana Chandrasekar
- Vascular Surgery Service, Department of General Surgery, Tan Tock Seng Hospital, Singapore
| | - Glenn Wei Leong Tan
- Vascular Surgery Service, Department of General Surgery, Tan Tock Seng Hospital, Singapore
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3
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Czerny M, Pacini D, Aboyans V, Al-Attar N, Eggebrecht H, Evangelista A, Grabenwöger M, Stabile E, Kolowca M, Lescan M, Micari A, Muneretto C, Nienaber C, de Paulis R, Tsagakis K, Rylski B, Braverman AC, Di Marco L, Eagle K, Falk V, Gottardi R. Current options and recommendations for the use of thoracic endovascular aortic repair in acute and chronic thoracic aortic disease: an expert consensus document of the European Society for Cardiology (ESC) Working Group of Cardiovascular Surgery, the ESC Working Group on Aorta and Peripheral Vascular Diseases, the European Association of Percutaneous Cardiovascular Interventions (EAPCI) of the ESC and the European Association for Cardio-Thoracic Surgery (EACTS). Eur J Cardiothorac Surg 2020; 59:65-73. [DOI: 10.1093/ejcts/ezaa268] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Accepted: 06/04/2020] [Indexed: 12/14/2022] Open
Abstract
Abstract
Since its clinical implementation in the late nineties, thoracic endovascular aortic repair (TEVAR) has become the standard treatment of several acute and chronic diseases of the thoracic aorta. While TEVAR has been embraced by many, this disruptive technology has also stimulated the continuing evolution of open surgery, which became even more important as late TEVAR failures do need open surgical correction justifying the need to unite both treatment options under one umbrella. This fact shows the importance of—in analogy to the heart team—aortic centre formation and centralization of care, which stimulates continuing development and improves outcome . The next frontier to be explored is the most proximal component of the aorta—the aortic root, in particular in acute type A aortic dissection—which remains the main challenge for the years to come. The aim of this document is to provide the reader with a synopsis of current evidence regarding the use or non-use of TEVAR in acute and chronic thoracic aortic disease, to share latest recommendations for a modified terminology and for reporting standards and finally to provide a glimpse into future developments.
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Affiliation(s)
- Martin Czerny
- University Heart Center Freiburg—Bad Krozingen, Faculty of Medicine, Albert Ludwigs University Freiburg, Freiburg, Germany
| | | | | | - Nawwar Al-Attar
- Golden Jubilee National Hospital, University of Glasgow, Glasgow, UK
| | | | | | | | - Eugenio Stabile
- Department of Advanced Biomedical Sciences, University of Napoli “Federico II”, Naples, Italy
| | | | - Mario Lescan
- Department of Cardiac, Thoracic and Vascular Surgery, University of Tübingen, Tübingen, Germany
| | - Antonio Micari
- Department of Cardiology, Humanitas Gavazzeni, Bergamo, Italy
| | | | | | | | | | - Bartosz Rylski
- University Heart Center Freiburg—Bad Krozingen, Faculty of Medicine, Albert Ludwigs University Freiburg, Freiburg, Germany
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4
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Hirano K, Tokui T, Nakamura B, Inoue R, Inagaki M, Toyoshima H, Chino S, Watanabe F, Kato N, Maze Y. Hybrid Therapy for Mycotic Aortic Aneurysm with Stent-Graft and Video-Assisted Thoracoscopic Debridement. Ann Vasc Dis 2019; 12:69-73. [PMID: 30931062 PMCID: PMC6434360 DOI: 10.3400/avd.cr.18-00119] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Treating mycotic aortic aneurysm with thoracic endovascular aortic repair (TEVAR) remains controversial because of sustained infection post-treatment. In this study, an 83-year-old man, who had a ruptured mycotic thoracic aortic aneurysm, underwent salvage TEVAR. However, because an abscess appeared in the aneurysm on follow-up computed tomography, video-assisted thoracoscopic debridement (VATD) followed by continuous drainage was performed next and was successful in eliminating the infection from the abscess. Although frozen elephant trunk and proximal aortic arch repair were further required owing to another pseudoaneurysm, there was no sign of recurrent infection thereafter. The combination of TEVAR and VATD can be effective in treatment of mycotic aortic diseases in selected patients.
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Affiliation(s)
- Koji Hirano
- Department of Thoracic and Cardiovascular Surgery, Ise Red Cross Hospital, Ise, Mie, Japan
| | - Toshiya Tokui
- Department of Thoracic and Cardiovascular Surgery, Ise Red Cross Hospital, Ise, Mie, Japan
| | - Bun Nakamura
- Department of Thoracic and Cardiovascular Surgery, Ise Red Cross Hospital, Ise, Mie, Japan
| | - Ryosai Inoue
- Department of Thoracic and Cardiovascular Surgery, Ise Red Cross Hospital, Ise, Mie, Japan
| | - Masahiro Inagaki
- Department of Thoracic and Cardiovascular Surgery, Ise Red Cross Hospital, Ise, Mie, Japan
| | - Hirokazu Toyoshima
- Department of Infectious Diseases, Ise Red Cross Hospital, Ise, Mie, Japan
| | - Shuji Chino
- Department of Radiology, Ise Red Cross Hospital, Ise, Mie, Japan
| | - Fumiaki Watanabe
- Department of Respiratory Surgery, Matsusaka City Hospital, Matsusaka, Mie, Japan
| | - Noriyuki Kato
- Department of Radiology, Mie University Hospital, Tsu, Mie, Japan
| | - Yasumi Maze
- Department of Thoracic and Cardiovascular Surgery, Ise Red Cross Hospital, Ise, Mie, Japan
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5
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Editor's Choice – Current Options and Recommendations for the Treatment of Thoracic Aortic Pathologies Involving the Aortic Arch: An Expert Consensus Document of the European Association for Cardio-Thoracic Surgery (EACTS) & the European Society for Vascular Surgery (ESVS). Eur J Vasc Endovasc Surg 2019; 57:165-198. [DOI: 10.1016/j.ejvs.2018.09.016] [Citation(s) in RCA: 122] [Impact Index Per Article: 24.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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6
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Czerny M, Schmidli J, Adler S, van den Berg JC, Bertoglio L, Carrel T, Chiesa R, Clough RE, Eberle B, Etz C, Grabenwöger M, Haulon S, Jakob H, Kari FA, Mestres CA, Pacini D, Resch T, Rylski B, Schoenhoff F, Shrestha M, von Tengg-Kobligk H, Tsagakis K, Wyss TR, Debus S, de Borst GJ, Di Bartolomeo R, Lindholt J, Ma WG, Suwalski P, Vermassen F, Wahba A, von Ballmoos MCW. Current options and recommendations for the treatment of thoracic aortic pathologies involving the aortic arch: an expert consensus document of the European Association for Cardio-Thoracic surgery (EACTS) and the European Society for Vascular Surgery (ESVS). Eur J Cardiothorac Surg 2019; 55:133-162. [PMID: 30312382 DOI: 10.1093/ejcts/ezy313] [Citation(s) in RCA: 277] [Impact Index Per Article: 55.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Affiliation(s)
- Martin Czerny
- Department of Cardiovascular Surgery, University Heart Center Freiburg-Bad Krozingen, Freiburg, Germany
| | - Jürg Schmidli
- Department of Cardiovascular Surgery, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Sabine Adler
- Department for Rheumatology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Jos C van den Berg
- Department of Radiology, Centro Vascolare Ticino, Ospedale Regionale di Lugano, Lugano, Switzerland.,Department of Radiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Luca Bertoglio
- Division of Vascular Surgery, "Vita salute" University, Ospedale San Raffaele, Milan, Italy
| | - Thierry Carrel
- Department of Cardiovascular Surgery, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Roberto Chiesa
- Division of Vascular Surgery, "Vita salute" University, Ospedale San Raffaele, Milan, Italy
| | - Rachel E Clough
- Division of Imaging Sciences and Biomedical Engineering, St Thomas' Hospital, King's College London, London, UK
| | - Balthasar Eberle
- Department for Anesthesiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Christian Etz
- Department of Cardiac Surgery, Heart Center Leipzig, Leipzig, Germany
| | | | - Stephan Haulon
- Aortic Center, Hôpital Marie Lannelongue, Université Paris Sud, Le Plessis-Robinson, France
| | | | - Fabian A Kari
- Department of Cardiovascular Surgery, University Heart Center Freiburg-Bad Krozingen, Freiburg, Germany
| | - Carlos A Mestres
- University Clinic for Cardiovascular Surgery, University Hospital Zurich, Zurich, Switzerland
| | | | - Timothy Resch
- Department of Vascular Surgery, Vascular Center Skåne University Hospital, Malmö, Sweden
| | - Bartosz Rylski
- Department of Cardiovascular Surgery, University Heart Center Freiburg-Bad Krozingen, Freiburg, Germany
| | - Florian Schoenhoff
- Department of Cardiovascular Surgery, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Malakh Shrestha
- Department of Cardio-thoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Hendrik von Tengg-Kobligk
- Department of Diagnostic, Interventional and Pediatric Radiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | | | - Thomas R Wyss
- Department of Cardiovascular Surgery, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
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7
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Lau C, Leonard JR, Iannacone E, Gaudino M, Girardi LN. Surgery for Acute Presentation of Thoracoabdominal Aortic Disease. Semin Thorac Cardiovasc Surg 2018; 31:11-16. [PMID: 30071280 DOI: 10.1053/j.semtcvs.2018.07.018] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2018] [Accepted: 07/24/2018] [Indexed: 01/16/2023]
Abstract
Thoracoabdominal aortic aneurysms are most commonly asymptomatic until there is either an impending aortic catastrophe or one that has already occurred. While open surgery remains the gold-standard method for repair, modern technology has led to the development of less invasive endovascular devices and techniques. We provide an expert review of open and endovascular therapies for 3 highly lethal thoracoabdominal aortic emergencies in order to highlight expectations for both short- and long-term outcomes in an era of evolving technology and improvements in patient evaluation and postoperative care. Open repair of ruptured thoracoabdominal aortic aneurysms is associated with a dramatic increase in all postoperative complications, even in specialized aortic surgery centers. Mycotic thoracic aortic aneurysms are highly lethal if surgical treatment is not initiated quickly as they have a propensity toward rapid growth and fatal rupture. Thoracic endovascular aortic repair is well-suited for the treatment of acute complicated type B aortic dissection with outcomes superior to open repair in some centers. Acute aortic events associated with thoracoabdominal aneurysms represent technically challenging situations that require rapid diagnosis and treatment to avoid a fatal outcome. Endovascular techniques have evolved as a viable alternative therapy for acute complicated type B aortic dissection or as a bridge to more definitive repair in the setting of infection or rupture.
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Affiliation(s)
- Christopher Lau
- Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, New York
| | - Jeremy R Leonard
- Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, New York
| | - Erin Iannacone
- Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, New York
| | - Mario Gaudino
- Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, New York
| | - Leonard N Girardi
- Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, New York.
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8
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Li PS, Tsai CL, Hu SY, Lin TC, Chang YT. Spontaneous hemothorax caused by ruptured multiple mycotic aortic aneurysms: a case report and literature review. J Cardiothorac Surg 2017; 12:109. [PMID: 29197388 PMCID: PMC5712197 DOI: 10.1186/s13019-017-0665-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2017] [Accepted: 11/16/2017] [Indexed: 11/24/2022] Open
Abstract
Background Mycotic aortic aneurysm (MAA) is a rare clinical entity with an incidence of 1-3%, but it is a life-threatening infection of aorta characterized by dilatation of aorta with false lumen. Multiple MAAs have been reported rarely with an incidence of 0.03% and associated with a high mortality rate of 80% if ruptured. Case presentation A hypertensive and diabetic 78-year-old man visited our emergency department complaining intermittent dull and tingled pain over the left flank region for 1 week. Chest X-ray showed left pleural effusion and hemothorax was confirmed by thoracocentesis. Computed tomography (CT) of chest demonstrated multiple thoracic aortic aneurysms and the pathological findings disclosed the diagnosis of multiple MAAs. He was discharged under an uneventful condition post-surgical aortic repair with adequate intravenous antibiotics for 4 weeks. Conclusions CT scan may make a definite diagnosis of multiple MAAs and management with surgical debridement, aortic repair and full-course antibiotics for Gram-positive coccus and/or Gram-negative bacillus is recommended.
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Affiliation(s)
- Po-Sung Li
- Department of Emergency Medicine, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Chung-Lin Tsai
- Division of Cardiac Surgery, Cardiovascular Center, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Sung-Yuan Hu
- Department of Emergency Medicine, Taichung Veterans General Hospital, Taichung, Taiwan. .,School of Medicine, Chung Shan Medical University, Taichung, Taiwan. .,Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan. .,Department of Nursing, College of Health, National Taichung University of Science and Technology, Taichung, Taiwan. .,Department of Nursing, Central Taiwan Univeristy of Science and Technology, Taichung, Taiwan. .,, 1650 Taiwan Boulevard Sect. 4, Taichung, 40705, Taiwan.
| | - Tzu-Chieh Lin
- Department of Emergency Medicine, Taichung Veterans General Hospital, Taichung, Taiwan.,School of Medicine, Chung Shan Medical University, Taichung, Taiwan.,Department of Nursing, College of Health, National Taichung University of Science and Technology, Taichung, Taiwan.,College of Public Health, China Medical University, Taichung, Taiwan
| | - Yao-Tien Chang
- Department of Emergency Medicine, Taichung Veterans General Hospital, Taichung, Taiwan.,School of Medicine, Chung Shan Medical University, Taichung, Taiwan.,Department of Nursing, College of Health, National Taichung University of Science and Technology, Taichung, Taiwan
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9
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Czerny M. Predictable or fateful-a short guide for how to anticipate risk to keep the incidence of aortoesophageal fistulation to a minimum. J Thorac Cardiovasc Surg 2017; 155:41-42. [PMID: 29029817 DOI: 10.1016/j.jtcvs.2017.09.043] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2017] [Accepted: 09/09/2017] [Indexed: 12/29/2022]
Affiliation(s)
- Martin Czerny
- University Heart Center Freiburg-Bad Krozingen, Südring, Germany.
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10
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Shahi N, Kwon JJ, Arosemena M, Salvatore DM, DiMuzio PJ, Abai B. Endovascular Repair of Ruptured Infected Arteries as a Temporizing Measure Versus Destination Therapy. Vasc Endovascular Surg 2016; 50:373-9. [DOI: 10.1177/1538574416655894] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective: Mycotic rupture of the arteries is a rare but deadly disorder. Current management typically involves open surgical repair. However, endovascular repair is a potential treatment that can be used to delay open repair, especially in acutely unstable patients. A case report and review of the literature was conducted to determine whether endovascular therapy could be a destination therapy for patients with arterial rupture secondary to infection. Methods: We present the case of a 72-year-old man with a left common iliac artery aneurysm rupture secondary to Salmonella infection treated with endovascular therapy upon initial presentation. A literature review of PubMed yielded 29 patients with ruptured aortic and iliac infected aneurysms that were initially treated with endovascular repair. Results: Majority of the patients (76.7%, 23 of 30) were successfully treated with the endovascular treatment and did not require open revision. These patients were often placed on long-term antibiotics. Conclusion: The literature review supports endovascular repair with a stent graft as a temporizing measure for infected ruptured arteries in an emergent setting and, in select cases, as a destination therapy.
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Affiliation(s)
- Niti Shahi
- Department of Surgery, Sidney Kimmel Medical College, Thomas Jefferson University Hospitals, Philadelphia, PA, USA
| | - Jeontaik J. Kwon
- Department of Surgery, Sidney Kimmel Medical College, Thomas Jefferson University Hospitals, Philadelphia, PA, USA
| | - Mariano Arosemena
- Department of Surgery, Sidney Kimmel Medical College, Thomas Jefferson University Hospitals, Philadelphia, PA, USA
| | - Dawn M. Salvatore
- Department of Surgery, Sidney Kimmel Medical College, Thomas Jefferson University Hospitals, Philadelphia, PA, USA
| | - Paul J. DiMuzio
- Department of Surgery, Sidney Kimmel Medical College, Thomas Jefferson University Hospitals, Philadelphia, PA, USA
| | - Babak Abai
- Department of Surgery, Sidney Kimmel Medical College, Thomas Jefferson University Hospitals, Philadelphia, PA, USA
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11
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Myers PO, Gemayel G, Mugnai D, Murith N, Kalangos A. Endovascular Exclusion of Aortoesophageal Fistula After Coarctation Extraanatomical Bypass. Ann Thorac Surg 2014; 98:314-6. [DOI: 10.1016/j.athoracsur.2013.09.026] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2013] [Revised: 08/24/2013] [Accepted: 09/05/2013] [Indexed: 10/25/2022]
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12
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Okada K, Yamanaka K, Sakamoto T, Inoue T, Matsumori M, Kawakami F, Okita Y. In situ total aortic arch replacement for infected distal aortic arch aneurysms with penetrating atherosclerotic ulcer. J Thorac Cardiovasc Surg 2014; 148:2096-100. [PMID: 24607377 DOI: 10.1016/j.jtcvs.2014.02.015] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2013] [Revised: 12/22/2013] [Accepted: 02/03/2014] [Indexed: 10/25/2022]
Abstract
BACKGROUND We present a series of patients who underwent in situ total aortic arch replacement for infected distal aortic arch aneurysms. METHODS Between 2002 and 2013, 9 patients with infected distal aortic arch aneurysms underwent total aortic arch replacement using antegrade selective cerebral perfusion. There were 4 male and 5 female patients with a mean age of 72.7±9.0 years. All patients had penetrating atherosclerotic ulcer in the distal aortic arch, which formed saccular aneurysms. Four patients had preoperative hoarseness. Maximum preoperative white blood cell count was 10,211±4375/μL, and mean serum C-reactive protein concentration was 12.7±7.2 mg/dL. Causative microorganisms were identified by blood culture or aortic wall culture and were as follows: Candida albicans, Pseudomonas aeruginosa, Edwardsiella tarda, Streptococcus dysgalactiae, Listeria monocytogenes, Staphylococcus aureus (2 cases), and unknown (2 cases). Radical debridement with in situ total aortic arch replacement was performed in all patients, followed by the omental flap grafting in 7 patients. All surgery was performed on an urgent or emergency basis. RESULTS Average cardiopulmonary bypass time and lower body circulatory arrest time were 199.7±50.7 minutes and 66.6±13.8 minutes, respectively. There was no in-hospital mortality, but 1 patient died of asphyxia 5 months after hospital discharge. Freedom from recurrence of infection was 100%. CONCLUSIONS Surgical treatment with the combination of radical debridement with in situ total aortic arch replacement using antegrade selective cerebral perfusion and omental flap grafting was a reliable procedure for the treatment of infected distal aortic arch aneurysms.
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Affiliation(s)
- Kenji Okada
- Division of Cardiovascular Surgery, Department of Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Katsuhiro Yamanaka
- Division of Cardiovascular Surgery, Department of Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Toshihito Sakamoto
- Division of Cardiovascular Surgery, Department of Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Takeshi Inoue
- Division of Cardiovascular Surgery, Department of Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Masamichi Matsumori
- Division of Cardiovascular Surgery, Department of Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Fumi Kawakami
- Department of Diagnostic Pathology, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Yutaka Okita
- Division of Cardiovascular Surgery, Department of Surgery, Kobe University Graduate School of Medicine, Kobe, Japan.
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13
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Usui A. Surgical management of infected thoracic aneurysms. NAGOYA JOURNAL OF MEDICAL SCIENCE 2013; 75:161-7. [PMID: 24640172 PMCID: PMC4345670] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/07/2013] [Accepted: 05/29/2013] [Indexed: 11/12/2022]
Abstract
Infected thoracic aortic aneurysm (ITAA) is a relatively rare disease. The diagnosis of ITAA is generally made comprehensively based on symptoms, laboratory data and CT findings. Several series of blood cultures are mandatory to first detect the infecting organism. ITAA is usually suspected as a result of the CT findings. A short-interval CT re-examination is essential to confirm the correct diagnosis. A CT scan commonly demonstrates a rapid enlargement of the aneurismal lumen and soft tissue mass surrounding the aorta. One of the characteristics of ITAA is the presence of several nodular or saccular aneurysms localized in different aortic portions. Patients with ITAA are associated with high incidences of aneurismal rupture due to the aneurysm's abrupt growth. Therefore, ITAAs are associated with both high morbidities and mortalities. The major concerns regarding surgical treatment for ITAA are the control of infection, the resection of whole infected tissue, grafting via an aseptic route and the prevention of recrudescent infection. Therefore, effectual antibiotic therapy is mandatory as the first choice of therapy. Ideally surgical intervention is indicated in patients with a controlled infection. It is essential to excise the whole infected aneurysm and to reconstruct in-situ grafting via an aseptic route. However, urgent surgery is often required in patients with an uncontrolled infection because they have an impending aneurismal rupture. In such cases, an extra-anatomical bypass without cardiopulmonary bypass is applicable. Surgical strategies should therefore be determined on a case-by-case basis because these patients present various clinical courses.
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