In Situ Prosthetic Graft Repair of a Mycotic Aneurysm of the Aorta After Orthotopic Liver Transplantation

Abstract

The use of in situ prosthetic grafts for repair of mycotic aneurysms is appropriate in certain situations and may be life-saving.

Successful endovascular management of multiple mycotic aneurysms after liver transplantation – A case report and review of the literature

“…10 However, as patients after liver transplantation receive immunosuppression, organisms which are typically not associated with mycotic aneurysms such as Enterococcus spp., Candida spp., and Aspergillus fumigatus are equally as common and have been described in literature. 3,5,8 Moreover, like our reported patient, mycotic vascular complications after liver transplantation tended to be associated with multiple organisms. Several risk factors such as the use of arterial conduits with multiple vascular anastomoses, perioperative systemic or intra-abdominal infection, bile leaks, relaparotomy and re-transplantation have been postulated to increase the risk of development of mycotic complications after liver transplantation.…”

“…4 The eventual end-point of a mycotic aneurysm or pseudoaneurysm inevitably ends with rupture, and patients can present with sudden intraperitoneal haemorrhage due to rupture. 5,8,9 The diagnosis of a mycotic vascular complication is made when a positive blood culture is present, or if organisms are isolated from the aneurysmal tissue obtained during surgery. Staphylococcus aureus and Salmonella are the most common organisms associated with the development of mycotic aneurysms due to their propensity to adhere to arterial walls.…”

“…Several risk factors such as the use of arterial conduits with multiple vascular anastomoses, perioperative systemic or intra-abdominal infection, bile leaks, relaparotomy and re-transplantation have been postulated to increase the risk of development of mycotic complications after liver transplantation. [3][4][5][6]8 These factors increase the risk of mycotic complications by causing direct bacterial inoculation during the time of surgery, bacteraemic seeding or direct extension of a local infection.…”

“…2,3,6 Mycotic aneurysms involving the aorta may develop after the use of an arterial conduit and can be managed with open aortic replacement with a synthetic tube graft. 5 Alternatively, in recent years, endovascular techniques have been utilized in the management of mycotic aneurysms or pseudoaneurysms, especially in patients with a prohibitive risk of open surgery. In our report, we described a patient who developed sequential mycotic vascular complications which were treated using endovascular stenting.…”

“…4 The eventual end-point of a mycotic aneurysm or pseudoaneurysm inevitably ends with rupture, and patients can present with sudden intraperitoneal haemorrhage due to rupture. 5,8,9…”