A Mycobacterium bovis Mycotic Abdominal Aortic Aneurysm Resulting From Bladder Cancer Treatment, Resection, and Reconstruction With a Cryopreserved Aortic Graft

Abstract

Mycotic abdominal aortic aneurysms (AAAs) are a clinical challenge for vascular surgeons due to their critical location, surrounding inflammation, risk of rupture, and danger of reinfection following treatment. We present a case of Mycobacterium bovis AAA in a 69-year-old male after treatment with intravesicular bacillus Calmette-Guérin (BCG) therapy for bladder carcinoma. The classical approach for mycotic AAA entails extra-anatomic reconstruction followed by resection with oversewing of the proximal and distal aortic stumps. Alternative in-line reconstruction options have also been advocated. This case illustrates a technically straightforward, durable, in-line repair within an infected field utilizing cryopreserved aortic allograft.

A mycotic aneurysm of the abdominal aorta caused by Mycobacterium bovis after intravesical instillation with bacillus Calmette-Guérin

“…Although it is a rare complication, increasing cases of aortic aneurysm secondary to M. bovis infection after intravesical BCG therapy have been reported, mainly in the past two decades. 3 , 4 , 5 , 6 , 7 , 8 , 9 , 10 , 11 , 12 Leo et al reviewed 20 cases and noted that patients often present with unspecified symptoms (weight loss, fatigue, malaise) that are often misinterpreted. They also noted a substantial spread in the time interval from BCG treatment to symptoms, ranging from 14 to 77 months.…”

Mycotic Thoracic Aortic Aneurysm After Intravesical Bacillus Calmette–Guérin Treatment

“…The majority of patients present with aneurysm rupture, as in our patient, and the aneurysms typically involve the abdominal aorta. Bacillus Calmette-Gu erin-associated mycotic aneurysms of the carotid, femoral, iliac, and popliteal arteries have also been reported, with only 2 cases of thoracic aorta involvement, neither of which was treated surgically [2][3][4][5][6][7].…”

“…In a series of 2,500 patients, infectious complications were noted in less than 1% of patients [2]. To date, fewer than 30 cases of BCG-associated mycotic aneurysms have been reported, with only 2 cases involving the thoracic aorta [3][4][5][6][7][8]. We have described the first case of an M bovis mycotic thoracic aorta aneurysm that was successfully treated with resection.…”

Systematische Übersichtsarbeit: aortale Komplikationen nach intravesikaler Bacillus Calmette-Guérin-Behandlung

“…Insgesamt erfolgte somit eine Volltextanalyse von 99 Manuskripten. Davon erfüllten 55 Publikationen [14,15,16,17,18,19,20,21,22,23,24,25,26,27,28,29,30,31,32,33,34,35,36,37,38,39,40,41,42,43,44,45,46,47,48,49,50,51,52,53,54,55,56,57,58,59,60,61,62,63,64,65,…”