Extra-anatomic Bypass Grafting after Endovascular Embolization for the Treatment of Mycotic Aneurysm - 2 case reports -

Abstract

Mycotic aneurysm is a disease requiring immediate treatment because of the high risk of rupture. A difficult surgical approach, especially in the case of occurrence on the iliac artery, involving endovascular embolization and extra-anatomic bypass grafting, is known to be a suitable treatment. We performed extra-anatomic bypass grafting after endovascular embolization successfully in two patients. The postoperative computed tomography of both patients showed complete exclusion of the mycotic aneurysm.

Mycotic Aneurysm in the Aortoiliac Area – Current Options for Treatment

“…Many authors highlight the high risk of rupture as the first manifestation of the infected aneurysm [4,14]. The diagnosis is settled with the help of an ultrasound and CT (or MR) angiography (similar to our case histories) [4,15]. There is a variety of treatment modalities of the mycotic aneurysm: In urgent situations or in cases where the infection is revealed only at the moment of the acute surgery, in situ replacement with a vascular prosthesis impregnated with salts of silver and/or rifampicin may be considered.…”

“…A replacement with an arteficial prosthesis in the in situ position is improper in high-virulent bacteria and yeasts (Staphylococcus aureus and other pyogenic cocci, Salmonella species, etc.) because of the extremely high risk of developing a prosthetic infection [2, 15,16]. We met the same situation in Case 1, with a good long-term result.…”

“…For these aneurysms tend to grow fast and pose a high-risk situation for early aneurysm rupture. The treatment modality for a patient with the mycotic aneurysm in the aortoiliac area is always selected with regard to the complex estimation of the condition of the patient, his habitus and comorbidities, as well as morphology of the aneurysm and iliac arteries, the type of infectious agent and institutional experience [15].…”

“…In case of a large aneurysm or a less favorable location, we can consider implantation of a bifurcated stent-graft [23]. Or an aorto-uniiliac stent-graft, possibly with a coil-embolization of the dilated iliac arteries; and with implantation of a prosthetic femoral crossover bypass [9,15,24]. Besides both the surgical as well as the endovascular treatment there is an indication for antibiotic therapy.…”

Single-Center Experience on Extra-Anatomic Arterial Revascularisation Applications

“…Extra-anatomic bypass grafts such as axillofemoral and subclavio-femoral femoro-femoral can be applied in the patients having the infected aortic grafts, in the patients undergoing colostomy and ileostomy after the previous laparotomy, having acute myocardial infarction, severe congestive heart failure, severe chronic renal disease or renal failure requiring hemodialysis, malignancy, resting dyspnea, patients with chronic obstructive pulmonary disease (COPD) [8,9]. Axillo-femoral bypass grafting may be preferred instead of femoro-femoral bypass in patients with operation-related graft infections [10].…”