Endovascular Repair of Mycotic Aneurysm of the Descending Thoracic Aorta: Diagnostic and Therapeutic Dilemmas—Two Case Reports with 1-Year Follow-Up

Abstract

A mycotic aneurysm of the thoracic aorta is a rare diagnosis with high mortality. We present two cases of endovascular reconstruction of mycotic descending thoracic aorta. Specific or nonspecific bacterial or other infectious agent in serial samples of blood, urine, cerebrospinal fluid, and pleural puncture was not detected in the first case, but we found in sputum sample Mycobacterium tuberculosis in the second patient. We empirically began by administering broad-spectrum intravenous antibiotics in the first case, with preoperative antibiotic prophylaxis and antituberculotic drugs therapy in the second case, and continued with the same medication for 4 months after endovascular repair. Control computed tomographic scans 6 months after reconstruction showed no endoleak in both patients. Repair of mycotic descending thoracic aortic aneurysms by endoluminal stent graft is reasonable alternative to open surgical intervention. A broad-spectrum antibiotic therapy has a high significance in the treatment of patients with mycotic aneurysm.

A mycotic aortic aneurysm treated by thoracic endovascular aneurysm repair

“…To prevent infection, the omentum or a muscle flap is used to cover the infected field. The mortality for open mycotic aortic aneurysm repair is almost 40% [1,5,6]. As shown by Sörelius et al.…”

“…A lower mortality rate is associated with endovascular treatment of mycotic aortic aneurysms supported with antibiotics from the beginning of treatment, though a stent graft is put in an infected filed [6,9]. Although there is no consensus on the optimal duration of antibiotic therapy, parenteral antibiotics are commonly given for 2–8 weeks after surgery [2].…”

Miliary tuberculosis in a patient with tuberculous mycotic aneurysm of the abdominal aorta: Case report and review of the literature

“…A review of the English literature from 2008 to today revealed 28 more cases (Table 1) [3], [7], [8], [9], [10], [11], [12], [13], [14], [15], [16], [17], [18], [19], [20], [21], [22], [23], [24], [25], [26], [27], [28], [29], [30], [31], [32], [33], specifically 18 men and 10 women with a mean age of 44.64 ± 18.16 years (range 16–84). 7 patients had a history of pulmonary tuberculosis and had previously received anti-tuberculosis medication.…”