ObjectiveThis study was performed to assess the efficacy and outcome of endovascular
aneurysm repair (EVAR) for treatment of primary mycotic aortic aneurysms
(PMAAs).MethodsFourteen consecutive patients who presented with PMAA from April 2010 to July
2017 were retrospectively reviewed. Preoperative, intraoperative, and
postoperative clinical data were recorded, and late infection-related
complications and long-term survival were assessed.ResultsThe aneurysms were located in the abdominal aorta in 10 patients and in the
left common iliac artery in 4 patients. Positive microbial cultures were
found in 12 patients, including Salmonella species in 11
and Streptococcus in 1. The remaining two patients had
negative culture results. Ten patients received preoperative antibiotics
before elective EVAR for 7 ± 9 days after admission. Four patients who
underwent emergent EVAR due to ruptured aneurysms were given their first
dose of antibiotics before EVAR. Three patients underwent surgical drainage,
and six underwent percutaneous drainage within 30 days after EVAR. No death
occurred within 30 days of the initial procedure. The mean follow-up was
34.8 (range, 3–84 months). One patient underwent re-intervention to resolve
obstruction of the iliac/femoral artery 5 months postoperatively. Relapse of
infection occurred in six patients (42.8%) during follow-up;
infection-related death occurred in three of these patients. The other
patients recovered with either conversion to open radical surgery or medical
therapy. The actuarial 7-year survival after EVAR was 75.7%.ConclusionsEVAR and aggressive antibiotic therapy might be suitable for PMAAs. Favorable
results may be typical for infection caused by
Salmonella.
fTEVAR using PMSGs may be a viable alternative for patients who present with ABAD without healthy proximal landing zones and who are unable to wait for a custom made fenestrated device.
Acute mesenteric ischemia is a condition with a high mortality rate. In the present study, a novel hybrid technique for the treatment of acute mesenteric ischemia was investigated. The retrospective study population included six patients, of which five were male and one was female, with a mean age of 69 years (age range, 59-73 years). The hybrid technique involved isolating the superior mesenteric artery (SMA) for cannulation and subsequently performing a fluoroscopically-assisted embolectomy, retrograde balloon angioplasty and stenting. Intra-arterial, catheter-directed thrombolysis was performed if required. Bowels showing evident necrosis were resected, while ischemic bowels with the potential for recovery were left for 48 h before being re-examined during the second-look surgery. Retrograde open mesenteric stenting (ROMS) was successfully performed on two patients without bowel resection. Four patients were successfully treated by intra-arterial catheter-directed thrombolysis following recanalization of the SMA, and the ischemic bowels had exhibited a full recovery by the second-look operation. Three patients underwent a massive bowel resection, but did not develop short bowel syndrome. Two patients developed acute renal failure, one of which recovered after 10 days of dialysis, while the other patient succumbed to acute renal failure. In the five surviving patients, the SMA remained patent for the duration of the follow-up period. Therefore, ROMS was shown to be a viable alternative procedure for emergent SMA revascularization. In addition, intra-arterial catheter-directed thrombolysis following recanalization of the SMA was demonstrated as an alternative technique for inhibiting necrosis in bowels with acute mesenteric ischemia.
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