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Endovascular management of ruptured, mycotic abdominal aortic aneurysm

J Eduardo Corso1, Karthikeshwar Kasirajan, Ross Milner

  • 1Division of Vascular Surgery, Department of Surgery, Emory University School of Medicine, Atlanta, Georgia , USA.

The American Surgeon
|July 28, 2005
PubMed

Insights

Endovascular repair is a viable treatment for ruptured mycotic abdominal aortic aneurysms, offering a less invasive option for high-risk patients. This approach shows promise in improving outcomes for complex aortic conditions.

Area of Science:

  • Vascular Surgery
  • Infectious Diseases
  • Interventional Radiology

Background:

  • Mycotic aneurysms carry a high mortality rate, with traditional surgical repair presenting significant challenges and complications.
  • Existing reluctance to use endografts in infected fields necessitates exploring alternative treatment strategies.
  • The case highlights the need to re-evaluate current treatment paradigms for mycotic aneurysms.

Observation:

  • A 63-year-old male patient with severe comorbidities and methicillin-sensitive Staphylococcus aureus presented with a contained rupture of a mycotic abdominal aortic aneurysm.
  • Magnetic resonance angiography (MRA) confirmed the rupture, leading to emergent endovascular repair.
  • The procedure involved an aortomono-iliac device, coil embolization, and femoral-femoral bypass.

Findings:

  • The patient required 6 units of red blood cells on admission but no further transfusions post-procedure.
  • Successful endovascular repair was achieved, with the patient discharged in good condition and remaining well at 1-year follow-up on antibiotics.
  • This case demonstrates the feasibility of endovascular management for ruptured mycotic abdominal aortic aneurysms.

Implications:

  • Endovascular repair presents an attractive, potentially life-saving option for medically compromised patients with ruptured mycotic aneurysms.
  • This approach may offer a lower mortality rate compared to traditional open surgical repair in high-risk populations.
  • Further long-term follow-up studies are crucial to establish the definitive efficacy of endovascular repair for these complex cases.

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