Hybrid operation for infectious thoracic and abdominal aortic aneurysms complicated with Bacillus Calmette–Guérin therapy for bladder cancer

Abstract

Rational: Bacillus Calmette–Guérin (BCG) intravesical instillation therapy is a widely used treatment for bladder cancer; however, an infectious aneurysm has been reported as a rare complication. Patient concerns: A 76-year-old man who underwent BCG intravesical instillation therapy for bladder cancer presented with prolonged dull back pain for 3 months. Diagnosis: Computed tomography (CT) revealed both thoracic and abdominal aortic aneurysms (AAAs). Follow-up CT at 4 weeks after the initial examination showed rapid enlargement of both aneurysms and typical findings of inflammation. Therefore, he was diagnosed with an impending rupture of infectious aneurysms. Interventions: Although open surgical resection of both aneurysms and vascular reconstruction were ideal, these operations were considered highly invasive for the patient. Therefore, a hybrid operation consisting of simultaneous endovascular repair of the thoracic aneurysm and open surgery of the abdominal lesion was performed. Outcomes: BCG “Tokyo-172” strain was identified in the resected sample from the aneurysmal wall, and he continued to receive oral antituberculosis drugs for 6 months. No sign of recurrent infection was observed 1 year after the operation. Lessons: A hybrid operation might be justified as an alternative to the conventional open surgical procedure, especially for patients with infectious aneurysms caused by weak pathogenic bacteria such as, the BCG mycobacteria.

Failed endovascular abdominal aortic aneurysm repair due to Mycobacterium bovis infection following intravesical bacillus Calmette-Guérin therapy

“…Since 1988, 51 cases of a mycotic AAA attributable to BCG therapy have been reported. 4 , 5 , 8 , 10 , 11 , 12 , 19 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 In our patient, infectious aortitis had progressed rapidly, and a saccular AAA or pseudoaneurysm had developed within 2 months after BCG therapy. In hindsight, a follow-up CT scan should have been performed sooner to monitor for any aneurysmal changes.…”

“…To the best of our knowledge, to date, 20 patients (including our patient) with a mycotic aortoiliac aneurysm who had undergone EVAR after BCG therapy have been reported ( Table ). 5 , 6 , 7 , 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 All 20 patients were men, and their mean age at diagnosis was 71 years (range, 57-82 years). The aneurysms had been diagnosed at a mean interval of 19 months (range, 0-69 months) after BCG therapy.…”

Case Report with Systematic Literature Review on Vascular Complications of BCG Intravesical Therapy for Bladder Cancer

“…Among the 17 reports identified in our systematic review, and the additional case we report in this article, a total of 18 cases were identified [ 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 ]. Notable clinical characteristics extracted from these literature reports were patient’s age and gender, aneurysm location, extravascular involvement, time between most recent BCG instillation and admission, number of instillations, culture site, culture results, surgical treatment, discharge therapy, and reported outcomes ( Table 1 ).…”

Systematische Übersichtsarbeit: aortale Komplikationen nach intravesikaler Bacillus Calmette-Guérin-Behandlung

“…Insgesamt erfolgte somit eine Volltextanalyse von 99 Manuskripten. Davon erfüllten 55 Publikationen [14,15,16,17,18,19,20,21,22,23,24,25,26,27,28,29,30,31,32,33,34,35,36,37,38,39,40,41,42,43,44,45,46,47,48,49,50,51,52,53,54,55,56,57,58,59,60,61,62,63,64,65,…”