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[Selective embolization of mycotic aneurysm of the branches of the abdominal aorta]
P Charlier1, A Cohen, C Eiferman
1Service de cardiologie, hôpital Bichat, Paris.
Abstract:
We report two cases of multiple aneurysm complicating bacterial endocarditis and involving the hepatic, renal and superior mesenteric arteries. The aneurysms were treated by the superselective embolization technique hitherto restricted to cerebral arteries. The first patient had been operated upon for mitral valve endocarditis. Because of a persistent anicteric cholestasis, repeat ultrasonography and computerized tomographic scan were performed which revealed two intrahepatic aneurysms associated, at arteriography, with an aneurysm of the superior mesenteric artery. The patient underwent superselective embolization of one of the intrahepatic aneurysms, then of the superior mesenteric artery aneurysm. Angiographic cure was obtained and persists after a 17-month follow-up. In the second patient, persistent clinical and biochemical hepatic abnormalities after mitral and aortic valve replacements for endocarditis prompted us to perform an ultrasonography which showed a large hepatic aneurysm, and an abdominal arteriography which disclosed the presence of several aneurysms. Because of its size and suspected fissuration, the hepatic aneurysm was treated by superselective embolization, and this was followed by embolization of a renal artery. The immediate post-treatment period was uneventful, and complete angiographic cure was confirmed after 6 months. Superselective embolization seems to give good results at mid-term and should therefore be considered for fragile patients with multiple abdominal aneurysms.
Insights
Superselective embolization successfully treated multiple abdominal aneurysms complicating bacterial endocarditis in two patients. This technique offers a promising mid-term solution for complex arterial conditions.
Area of Science:
- Vascular Surgery
- Interventional Radiology
- Infectious Diseases
Background:
- Bacterial endocarditis can lead to mycotic aneurysms in various arteries.
- Abdominal arterial aneurysms are rare complications of endocarditis, posing significant treatment challenges.
Observation:
- Two patients presented with multiple aneurysms involving hepatic, renal, and superior mesenteric arteries secondary to bacterial endocarditis.
- Initial management included valve replacement in both cases, followed by persistent hepatic abnormalities.
Findings:
- Superselective embolization, a technique typically used for cerebral arteries, was employed to treat the abdominal aneurysms.
- Both patients achieved angiographic cure with no immediate post-treatment complications, demonstrating mid-term efficacy at 6 and 17 months follow-up.
Implications:
- Superselective embolization is a viable and effective treatment for multiple abdominal mycotic aneurysms.
- This approach should be considered for fragile patients with complex arterial pathologies secondary to endocarditis.