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Endovascular Treatment of Mycotic Aortic Pseudoaneurysms with Stent-Grafts

  • Kurt TiesenhausenEmail author
  • Michael Hessinger
  • Maurice Tomka
  • Horst Portugaller
  • Shota Swanidze
  • Peter Oberwalder
Clinical Investigation

Abstract

Mycotic aortic aneurysms remain a therapeutic challenge, especially in patients who are not suitable for open surgery. Endovascular treatment with stent-grafts in this indication is still disputed. Between January 2002 and January 2006, six patients with mycotic aneurysms of the thoracoabdominal or abdominal aorta were admitted to our department. All patients were male, aged 57–83 years (mean, 74.6 years). The mycotic aneurysms were diagnosed on the basis of clinical signs of infection, on CT, and, in four cases, on a positive blood culture. In all patients the mycotic aortic aneurysms were treated endovascularly by stent-graft implantation. Technical and clinical success was achieved in all patients. There was no in-hospital or 30-day mortality. In the follow-up period (range, 2–47 months) four patients died of cancer, cardiac failure, or unknown cause (one case). Two patients are still alive with nearly complete regression of the aneurysms. We conclude that treatment of mycotic aortic aneurysms with stent-grafts may be an alternative in selected patients.

Keywords

Mycotic aortic aneurysm Stent-graft Endovascular treatment 

References

  1. 1.
    Koch L (1851) Über Aneurysmata der Arteria mesenterica superioris. Inaugural-Abhandlungen. Barfus Universitäts-Buchdruckerei, ErlangenGoogle Scholar
  2. 2.
    Osler W (1885) The Gulstonian lectures on malignant endocarditis. BMJ 1:467–470CrossRefGoogle Scholar
  3. 3.
    Pasic M (1996) Mycotic aneurysm of the aorta: evolving surgical concept. Ann Thorac Surg 61:1053–1054PubMedCrossRefGoogle Scholar
  4. 4.
    Lee KH, Won JY, Lee DY, et al. (2006) Stent-graft treatment of infected aortic and arterial aneurysms. J Endovasc Ther 13:338–345PubMedCrossRefGoogle Scholar
  5. 5.
    Gonzalez-Fajardo JA, Gutierrez V, Pedrosa MM, et al. (2005) Endovascular repair in the presence of aortic infection. Ann Vasc Surg 19:94–98PubMedCrossRefGoogle Scholar
  6. 6.
    Ishida M, Kato N, Hirano T, et al. (2002) Limitations of endovascular treatment with stent-grafts for active mycotic thoracic aortic aneurysm. CardioVasc Interv Radiol 25:216–218CrossRefGoogle Scholar
  7. 7.
    Chuter TAM, Lukaszewicz GC, Reilly LM, et al. (2000) Endovascular repair of a presumed aortoenteric fistula: late failure due to recurrent infection. J Vasc Ther 7:240–244Google Scholar
  8. 8.
    Burks JA, Faries PL, Gravereaux EC, et al. (2001) Endovascular repair of bleeding aortoenteric fistulas: a 5-year experience. J Vasc Surg 34:1055–1059PubMedCrossRefGoogle Scholar
  9. 9.
    Jones KG, Bell RE, Sabharwal T, et al. (2005) Treatment of mycotic aortic aneurysms with endoluminal grafts. Eur J Vasc Endovasc Surg 29:139–144PubMedCrossRefGoogle Scholar
  10. 10.
    Müller BT, Wegener OR, Grabitz K, et al. (2000) Mycotic aneurysms of the thoracic and abdominal aorta and iliac arteries: experience with anatomic and extraanatomic repair in 33 cases. J Vasc Surg 33:106–113CrossRefGoogle Scholar
  11. 11.
    Fillmore AJ, Valentine RJ (2003) Surgical mortality in patients with infected aortic aneurysms. J Am Coll Surg 196:435–441PubMedCrossRefGoogle Scholar
  12. 12.
    Noel AA, Glovicki P, Cherry KJ, et al. (2002) Abdominal aortic reconstruction in infected fields: early results of the United States Cryopreserved Aortic Allograft Registry. J Vasc Surg 35:847–852PubMedCrossRefGoogle Scholar
  13. 13.
    Oderich GS, Panneton JM, Bower TC, et al. (2001) Infected aortic aneurysms: aggressive presentation, complicated early outcome, but durable results. J Vasc Surg 34:900–907PubMedCrossRefGoogle Scholar
  14. 14.
    Hsu RB, Chen RJ, Wang SS, et al. (2004) Infected aortic aneurysms: Clinical outcome and risk factors analysis. J Vasc Surg 40:30–35PubMedCrossRefGoogle Scholar
  15. 15.
    Semba CP, Sakai T, Slonim SM, et al. (1998) Mycotic aneurysms of the thoracic aorta: repair with use of endovascular stent-grafts. J Vasc Interv Radiol 9:33–40PubMedGoogle Scholar
  16. 16.
    Kinney EV, Kaebnick HW, Mitchell RA, et al. (2000) Repair of mycotic paravisceral aneurysm with a fenestrated stent-graft. J Endovasc Ther 7:192–197PubMedCrossRefGoogle Scholar
  17. 17.
    Koeppel TA, Gahlen J, Diehl S, et al. (2004) Mycotic aneurysm of the abdominal aorta with retroperitoneal abscess: successful endovascular repair. J Vasc Surg 40:164–166PubMedCrossRefGoogle Scholar
  18. 18.
    Madhavan P, McDonnell CO, Dowd MO, et al. (2000) Suprarenal mycotic aneurysm exclusion using a stent with a partial autologous covering. J Endovasc Ther 7:404–409PubMedCrossRefGoogle Scholar
  19. 19.
    Jorna FH, Verhoeven ELG, Bos WTJG, et al. (2006) Treatment of a ruptured thoracoabdominal aneurysm with a stent-graft covering the celiac axis. J Endovasc Ther 13:770–774PubMedCrossRefGoogle Scholar
  20. 20.
    Ting ACW, Cheng SWK, Ho P, et al. (2006) Endovascular stent graft repair for infected thoracic aortic pseudoaneurysms–a durable option? J Vasc Surg 44:701–705PubMedCrossRefGoogle Scholar
  21. 21.
    Stanley BM, Semmens JB, Lawrence-Brown MMD, et al. (2003) Endoluminal repair of mycotic thoracic aneurysms. J Endovasc Ther 10:511–515PubMedCrossRefGoogle Scholar
  22. 22.
    Kan C, Lee H, Yang Y (2007) Outcome after endovascular stent graft treatment for mycotic aortic aneurysm: a systemic review. J Vasc Surg 46:906–912Google Scholar
  23. 23.
    Forbes TL, Harding GEJ (2006) Endovascular repair of Salmonella-infected abdominal aortic aneurysms: a word of caution. J Vasc Surg 44:198–200PubMedCrossRefGoogle Scholar
  24. 24.
    Smith JJ, Taylor PR (2004) Endovascular treatment of mycotic aneurysms of the thoracic and abdominal aorta: the need for Level I evidence. Eur J Vasc Endovasc Surg. 27:569–570PubMedCrossRefGoogle Scholar
  25. 25.
    Berchtold C, Eibl C, Seelig MH, et al. (2002) Endovascular treatment and complete regression of an infected abdominal aortic aneurysm. J Endovasc Ther 9:543–548PubMedCrossRefGoogle Scholar
  26. 26.
    Tegler G, Sörensen J, Björck M, Savitcheva I, Wanhainen A (2007) Detection of aortic graft infection by 18-fluorodeoxyglucose positron emission tomography combined with computed tomography. J Vasc Surg 45:828–830PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2008

Authors and Affiliations

  • Kurt Tiesenhausen
    • 1
    Email author
  • Michael Hessinger
    • 1
  • Maurice Tomka
    • 1
  • Horst Portugaller
    • 2
  • Shota Swanidze
    • 1
  • Peter Oberwalder
    • 3
  1. 1.Department of Vascular SurgeryUniversity HospitalGrazAustria
  2. 2.Department of Interventional RadiologyUniversity HospitalGrazAustria
  3. 3.Department of Cardiac SurgeryUniversity HospitalGrazAustria

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