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Endoluminal repair of mycotic thoracic aneurysms
Brendan M Stanley1, James B Semmens, Michael M D Lawrence-Brown
1Repatriation General Hospital, Adelaide, South Australia. brenda.stanley@rgh.sa.gov.au
Purpose:
To report a series of endoluminally repaired mycotic thoracic aneurysms.
Case Reports:
Four patients with presumed mycotic aneurysms of the thoracic aorta were treated with endovascular grafts owing to overly high risk for open repair. All aneurysms were successfully excluded at the initial intervention. In one case, which required endograft fenestrations for the superior mesenteric and renal arteries, the patient died 53 days after the procedure, following graft migration and occlusion of major branch vessels. The other 3 patients remain alive and well at a mean follow-up of 16 months with no signs of ongoing sepsis.
Conclusions:
Endoluminal repair of thoracic mycotic aneurysms is technically feasible and, in association with long-term antibiotics, offers at least temporary protection against imminent rupture.
Insights
Endovascular repair of mycotic thoracic aneurysms is a feasible option for high-risk patients. This approach, combined with antibiotics, can temporarily prevent aneurysm rupture.
Area of Science:
- Vascular Surgery
- Interventional Cardiology
Background:
- Mycotic aneurysms of the thoracic aorta present a significant surgical challenge.
- Open repair carries a high risk of morbidity and mortality.
Observation:
- Four patients with thoracic aortic mycotic aneurysms underwent endovascular repair due to high surgical risk.
- All aneurysms were initially excluded successfully.
- One patient experienced graft migration and branch vessel occlusion, leading to death.
Findings:
- Endoluminal repair demonstrated technical feasibility in this series.
- Three patients remained stable with no signs of sepsis at a mean 16-month follow-up.
- Long-term antibiotics were used in conjunction with endovascular repair.
Implications:
- Endovascular repair offers a viable alternative for select patients with mycotic thoracic aneurysms.
- This technique may provide temporary protection against rupture.
- Further research is needed to assess long-term outcomes and optimize management strategies.