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Endovascular treatment for mycotic aneurysm using pyoktanin- applied devices
Kei Kazuno1, Hajime Kinoshita2, Mariko Hori3
1Department of Cardiovascular Surgery, Itabashi Chuo Medical Center, 2-12-7 Azusawa Itabashi-ku, Tokyo, 174-0051, Japan. kazuno@asahikawa-med.ac.jp.
Background:
Mycotic thoracic aortic aneurysm is an extremely rare but serious disease because it can easily rupture and has a high mortality rate. The standard therapy for it comprises graft replacement and debridement using systemic antibiotics; nonetheless, this has a high mortality rate and complications. Endovascular aortic repair is considered a bridging therapy before open surgery. However, we have used it at our institution for the radical treatment of mycotic thoracic aortic aneurysm utilizing pyoktanin (methylrosanilide chloride)-applied devices. Thus, the aim of this study was to report our clinical experience with pyoktanin-applied thoracic endovascular aortic repair for the treatment of mycotic thoracic aortic aneurysm, including its effects.
Methods:
From April 2017 to July 2019, we performed thoracic endovascular aortic repair using pyoktanin for eight cases of mycotic thoracic aortic aneurysm using Valiant®. During device preparation before insertion, pyoktanin was flushed from the side port instead of saline containing heparin.
Results:
There were no operative deaths, recurrences of infection, or major complications. Two cases died from pneumonia and cancer; the other six cases were alive during the follow-up period.
Conclusions:
Pyoktanin-applied thoracic endovascular aortic repair for mycotic thoracic aortic aneurysm treatment is effective. However, the appropriate use of antibiotics and bundled therapy is necessary at present.
Insights
Pyoktanin-applied thoracic endovascular aortic repair offers an effective treatment for mycotic thoracic aortic aneurysms, showing promising results in a recent clinical study. This approach may reduce complications associated with traditional methods.
Area of Science:
- Vascular Surgery
- Infectious Diseases
- Medical Device Innovation
Background:
- Mycotic thoracic aortic aneurysm is a rare, life-threatening condition with high mortality.
- Standard treatments like graft replacement and antibiotics have significant complication rates.
- Endovascular aortic repair (TEVAR) is typically a temporary measure before open surgery.
Purpose of the Study:
- To evaluate the clinical efficacy of pyoktanin-applied TEVAR for mycotic thoracic aortic aneurysm.
- To report on the outcomes and effects of this novel treatment approach.
Main Methods:
- Eight patients with mycotic thoracic aortic aneurysm underwent TEVAR using pyoktanin-applied devices (Valiant®).
- Pyoktanin was flushed through the device side port instead of heparinized saline during preparation.
- Data collected from April 2017 to July 2019.
Main Results:
- No operative deaths, infection recurrences, or major complications were observed.
- Six out of eight patients survived the follow-up period.
- Two patients died due to unrelated causes (pneumonia and cancer).
Conclusions:
- Pyoktanin-applied TEVAR is an effective treatment for mycotic thoracic aortic aneurysm.
- This method shows potential for radical treatment, reducing mortality and complications.
- Concomitant antibiotic therapy and bundled care remain crucial for optimal outcomes.
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