Endovascular Therapy for Distal Superior Mesenteric Artery Mycotic Aneurysms due to Infective Endocarditis

Abstract

Purpose: To report 3 patients with infective endocarditis who underwent transcatheter arterial embolization for mycotic aneurysm of the distal superior mesenteric artery (SMA). Case Report: Three men (60, 64, and 65 years old) were diagnosed with infective endocarditis. Antibiotics were initiated immediately after admission and continued for several weeks to months. Distal SMA mycotic aneurysm was identified on computed tomography in the vicinity of the ileocolic artery at 33, 26, and 30 days after admission. In case 1, the ileal artery was occluded distal to the aneurysm, with collateral flow to the ileum. In case 2, the mycotic aneurysm was located below the ileocolic artery, which was stenosed distal to the lesion. In case 3, the aneurysm was located on a branch of the ileal artery. Transarterial embolization using microcoils was successfully performed in all patients. No complications associated with embolotherapy or relapse of infection were observed in these 3 patients at 60, 30, and 15 months, respectively. Conclusion: Transcatheter arterial embolization for distal SMA mycotic aneurysm could provide an alternative to open surgery. Anatomical assessment of collateral flow and preprocedure long-term antibiotic therapy could play important roles in preventing bowel ischemia and minimizing the risk of infection relapse.

Endovascular Treatment of Superior Mesenteric Artery Pseudoaneurysm Due to Infective Endocarditis With Stent-Graft

“…Three cases of distal SMA aneurysms treated with TAE have been reported in the literature with a good prognosis. 4 In our case report, the aneurysm was located proximal to the SMA and was in the shape of a shuttle that expanded in all directions, so we did not opt for Coil embolization, but placed a stent graft directly after adequate antibiotics. For the small distal aneurysm in the distal trunck of the SMA, we did not perform concurrent coil embolization because it might increase the risk of small bowel necrosis.…”

“…We reviewed cases of SMA pseudoaneurysms caused by infective endocarditis published in the last decade through PubMed. [2][3][4][5][6][7][8][9][10][11][12][13][14][15] After counting a total of 21 cases, 15 of them were treated surgically (1 of which was laparoscopic), 3 were treated with TAE, 2 were treated medically, and 1 was treated with TAE combined with a covered stent. The specific treatment usually depends on the shape and location of the aneurysm, the patency of the distal and proximal branches, the blood supply to the intestine, and the patient's current signs-the prognosis for emergency cases is usually poor.…”

“…Three cases of distal SMA aneurysms treated with TAE have been reported in the literature with a good prognosis. 4…”

“…There are some reports of interventional treatment of SMA pseudoaneurysms caused by infective endocarditis, but mainly the aneurysms are embolized with coils. 4 There are no case reports on the treatment of SMA pseudoaneurysms due to infective endocarditis with overlapping stents with long-term follow-up.…”

Diagnosis and treatment of infective aneurysm of mesenteric artery due to infective endocarditis

“…After the diagnosis of infective endocarditis, a short interval of CT examination earlier suggested a possible infective aneurysm [12,13]. Before the onset of symptoms, patients are treated prophylactically, preventing surgical treatments such as bowel resection [14].…”