Endovascular treatment of a tuberculous infected aneurysm of the descending thoracic aorta: A word of caution

Abstract

An infected aneurysm of the thoracic aorta due to mycobacterium tuberculosis is an unusual entity for which the classical treatment is antituberculosis chemotherapy and open-chest surgery. Recent improvements in endovascular treatments have led to their proposed use for infected aneurysms in patients for whom open surgery poses too high a risk. We report on a 68-year-old man with a tuberculous aortic aneurysm who had been treated with an endoprosthesis and antituberculosis chemotherapy. His clinical and radiological follow-up was uneventful and led to the discontinuation of pharmacological treatment after 16 months. However, a recurrence of the infection led to a fatal aortic rupture 4 months after discontinuation of therapy.

A Rare but Potentially Lethal Case of Tuberculous Aortic Aneurysm Presenting with Repeated Attacks of Abdominal Pain

“…Open aortic reconstructive surgery is generally considered to be the standard of treatment for aortic aneurysms associated with aortitis, although endovascular techniques have recently been employed, with early reported successes (13)(14)(15). While endovascular treatment has the theoretical advantage of avoiding extensive manipulation of inflamed aortic tissue, thus preventing the morbidity and mortality associated with open surgery, there are downsides in patients with TB-infected aneurysms.…”

Tuberculous Pseudoaneurysm of the Descending Thoracic Aorta from Tuberculous Aortitis: CT Findings and Treatment with an Endovascular Stent Graft

“…Two of the five patients with thoracic aortic psedoaneurysms had poor outcomes. The other three patients recovered without complication (2,7,9,10).…”

“…Conventional treatment consists of surgical repair and antituberculosis chemotherapy (1)(2)(3)(4). Endovascular repair has been proposed as an alternative to open surgery in selected patients (2,7).…”

“…To our knowledge, there have been seven previous case reports which included endovascular treatment of tuberculous aortic psedoaneurysms, and five involving the thoracic aorta (2,6,7,9,10). Two of the five patients with thoracic aortic psedoaneurysms had poor outcomes.…”

“…However, this procedure is less invasive and is associated with improved mortality and morbidity compared to conventional open surgery, and provides a good treatment alternative for tuberculous pseudoaneurysm (2,6,7,10). This patient's miliary tuberculosis led us to avoid a surgical procedure and endovascular treatment could be a bridge treatment to curative surgical treatment during improvement of the miliary tuberculosis.…”