Six-year progression of medically treated infective aortitis

Area of Science:

• Vascular Surgery
• Infectious Diseases
• Cardiology

Background:

• Infective aortitis with mycotic aneurysms typically requires surgical intervention due to high mortality risks with non-operative management.
• Current recommendations strongly favor operative intervention combined with aggressive antibiotic therapy for infective aortitis.
• Long-term surveillance imaging data on the natural progression of mycotic aneurysms following medical management is limited.

Purpose of the Study:

• To document a case of infective aortitis with mycotic aneurysms managed non-operatively with long-term surveillance.
• To explore the natural progression of mycotic aneurysm sac growth during the acute infective period and over many years.
• To evaluate the outcomes of antibiotic therapy in a patient who refused surgical intervention for infective aortitis.

Main Methods:

• A 77-year-old female patient diagnosed with infective aortitis via computed tomography angiography.
• Patient refused operative intervention and was treated with intravenous ceftriaxone for 6 weeks and oral ciprofloxacin for 1 year.
• Long-term surveillance imaging was performed to monitor the mycotic aneurysmal disease progression.

Main Results:

• The patient developed rapid infrarenal and suprarenal mycotic aneurysmal disease post-diagnosis.
• The aneurysmal disease stabilized within one year of diagnosis and showed no further progression.
• The infection was successfully cleared with the prescribed antibiotic regimen.

Conclusions:

• Infective aortitis with mycotic aneurysms usually necessitates surgical treatment due to rupture risk.
• This case suggests that if the acute infective phase is successfully managed medically, aneurysmal disease may stabilize.
• Long-term non-operative management with surveillance imaging can be a viable option in select cases of infective aortitis.