Endovascular repair combined with staged drainage for the treatment of infectious aortic aneurysm: a case report

Abstract

Background Infectious aortic aneurysm, defined as a focal dilation of an infectious arterial wall, is an uncommon life-threatening disease. Compared with open surgery, endovascular repair yields acceptable clinical outcomes. However, residual tissue infection may increase the risk of secondary intervention. Here, we present a successful case of endovascular repair combined with staged drainage for the treatment of infectious aortic aneurysm. Case presentation A 58-year-old man presented to hospital with a 3-day history of lower back pain radiating to the back associated with fever. The dynamic imaging characteristics revealed rapid progress of infectious abdominal aortic aneurysm with negative blood culture. The patient underwent endovascular repair and salmonella enteritidis was identified through drain culture. Conclusions Endovascular procedure and staged drainage can be feasible and effective option in selected cases.

Aneurisma infeccioso primário da aorta: série de casos e revisão da literatura

“… 5 , 8 , 12 - 14 The best term is primary infectious aneurysm, which denotes a dilation secondary to infection of the aorta wall. 2 , 5 , 11 , 14 , 15 The condition is rare, 1 , 5 - 7 , 9 , 16 but highly lethal. 6 - 7 , 9 , 16 …”

“…In the West, infectious aneurysms account for no more than 3% of all aneurysms 1 , 2 , 5 , 6 , 8 , 9 , 11 , 14 , 16 - 18 and tend to occur in men 8 , 14 who are younger than those who develop degenerative aneurysms. 4 , 7 , 11 These aneurysms can grow rapidly and there is a high risk of rupture, 2 , 4 , 8 , 9 , 12 , 16 , 17 with mortality rates as high as 60%. 2 The following etiologic agents have been reported: gram-positive bacteria such as Staphylococcus sp.…”

“…1 , 2 , 5 , 11 , 14 , 17 , 19 After attaching to the artery wall, the microorganism provokes acute inflammation with neutrophilic infiltration, leading to activation of enzymes and weakening of the artery wall, 8 resulting in suppuration and arterial dilatation. 1 , 2 , 5 , 9 , 11 , 17 , 20 , 22 Aortic involvement is more common because of the more pronounced vasa vasorum of larger caliber arteries, which facilitates bacterial colonization. 8 , 11 , 14 , 19 …”

“… 6 - 8 Fever, pulsating mass, and abdominal pains are described classically, as are elevated inflammatory markers and positive blood cultures, but are not always present. 3 , 9 Treatment for this type of aneurysm must be initiated rapidly, with antibiotic therapy (ideally guided by cultures) and surgery. 1 , 6 - 9 Few surgeons accumulate experience with their treatment and the literature contains imprecise information on nomenclature, diagnostic criteria, and therapeutic strategies.…”

“… 3 , 9 Treatment for this type of aneurysm must be initiated rapidly, with antibiotic therapy (ideally guided by cultures) and surgery. 1 , 6 - 9 Few surgeons accumulate experience with their treatment and the literature contains imprecise information on nomenclature, diagnostic criteria, and therapeutic strategies. This article presents a series of three cases and highlights aspects of their clinical presentation, diagnosis, and treatment, in addition to reviewing the literature on the subject to help to standardize the management of this uncommon, but extremely serious, disease.…”