Mycotic Thoracic Aortic Aneurysm After Intravesical Bacillus Calmette–Guérin Treatment

Seastedt, Kenneth P.; Ahmad, Usman; Lau, Christopher; Ruggeri-Weigel, Patricia; Tsang, Hamilton C.; Hartman, Barry J.; Girardi, Leonard N.

doi:10.1016/j.athoracsur.2014.07.083

Cited by 12 publications

(3 citation statements)

References 7 publications

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“…Arterial pseudoaneurysm-saccular aneurysm can be seen on US or contrast-enhanced CT. Non-specific arteritis is also commonly seen. The abdominal aorta, thoracic aorta, femoral, popliteal and carotid arteries are affected in this order of decreasing frequency [42]. Additional troubles involving aorto-enteric and aorto-bronchial fistulas have been reported [32].…”

Section: Discussionmentioning

confidence: 98%

“…These patients have to be treated with open surgery and antimycobacterial therapy. Endovascular repair needs to be done but these patients who are poor candidates for surgery; associated hazard of future stent contamination should be considered [42]. Patients with pre-existing stent grafts who are on intravesical BCG treatment additionally might be at chance for future stent illness [43].…”

Section: Discussionmentioning

confidence: 99%

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Complications of intravesical BCG therapy in non-muscle invasive bladder cancer: our tertiary care centre experience

et al. 2020

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Background Urothelial bladder carcinoma accounts for around 3.9% cases of all the male cancers in India. Non-muscle-invasive bladder carcinoma (NMIBC) is predominant group which constitute approximately three fourth of the urothelial bladder cancer. Intravesical BCG immunotherapy is the corner stone of today’s NMIBC management. However, as with any other therapy it has its own complications and its interruption due to these adverse effects is a major cause of suboptimal efficacy. The aim of this study was to assess the complications of intravesical BCG therapy and their management in NMIBC patients. Methods This was a retrospective descriptive study conducted between October 2016 and November 2019; a backward review of 149 patients with diagnosis of NMIBC that undergone intravesicle BCG therapy was performed. Patient’s demographical, clinical, diagnostic and procedural data regarding bladder tumour, BCG therapy, its complications and management were collected and analysed. Results Total 149 patients were analysed, comprising 116 males and 33 females. The mean age was of 57.2 ± 6.7 years. Total 85.23% were primary and 14.76% were recurrent tumours. Total 96 patients (64.42%) completed the planned course, while 53 (35.57%) interrupted. The reasons for BCG interruption includes adverse effects (15.4%), progression of disease (6.7%), disease refractory to BCG (4.6%) and disease recurrence during BCG (3.3%). Most of the adverse events occurred in first 6 months and most interruptions occurred after the induction period. Cystitis was the most common observed adverse effect seen in 39.6% patients. Frequency, urgency, haematuria were common presentation. Radical cystectomy was the most common (16.10%) further treatment with patients whose treatment was interrupted. Conclusion BCG is an indispensable therapy available for NMIBC, but it is associated with array of adverse effects and complications, which are the main reasons for poor compliance to BCG therapy. Although BCG-related complications can affect any organ in the body, potentially life-threatening systemic BCG-related infections are encountered in only < 5% of patients. There are some difficulties in diagnosis of the BCG complications because acid-fast staining, culture and PCR test are not always positive; tissue biopsies should be indicated sometimes to evaluate histopathology and presence of M. bovis. A persistently monitored multidisciplinary approach with high index of suspicion and prompt anti-TB therapy can help to derive the maximum benefits while keeping the complications at check.

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Section: Discussionmentioning

confidence: 98%

Section: Discussionmentioning

confidence: 99%

Complications of intravesical BCG therapy in non-muscle invasive bladder cancer: our tertiary care centre experience

et al. 2020

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“…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,…”

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

et al. 2021

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Zusammenfassung Hintergrund Aortale Pathologien nach intravesikaler BCG-Applikation (BCG: Bacillus Calmette-Guérin) stellen eine seltene Komplikation nach der Behandlung von nicht muskelinvasiven Harnblasentumoren dar. Das Ziel dieser Studie war es, eine deskriptive Analyse der bisher publizierten Studien im Rahmen einer systematischen Übersichtsarbeit durchzuführen und die besonderen Herausforderungen der Diagnosestellung und Behandlung dieser seltenen Komplikation zu diskutieren. Material und Methode Es erfolgte eine Literaturrecherche in den Datenbanken PubMed (1949–2021) und Web of Science (1900–2021) mit den Suchtermini „mycobacterium“ OR „bovis“ OR „BCG“ AND „aorta“ OR „aneurysm“. In einem stufenweisen Bewertungsverfahren wurden Publikationen mit folgenden Einschlusskriterien in die finale Datenauswertung eingeschlossen: Originalarbeit, Volltextverfügbarkeit in englischer oder deutscher Sprache und aortale Komplikation nach intravesikaler BCG-Instillation. Ergebnisse In 55 publizierten Arbeiten wurden insgesamt 60 Einzelfälle beschrieben. BCG-induzierte, mykotische Aortenaneurysmen können in allen Segmenten der Aorta auftreten, wobei das infrarenale Aortensegment am häufigsten betroffen war (65% aller Fälle). Häufig handelte es sich um sakkuläre (65%) Aussackungen mit (28%) oder ohne Aortenruptur (63%). Begleitinfektionen in anderweitigen Geweben waren typisch (65%). Die Diagnose beruhte auf der Kombination aus pathologischen und mikrobiologischen Analysemethoden. Ein gängiger Therapiealgorithmus war die chirurgische Infektsanierung (85%) und die antimykobakterielle Therapie (83%). Gleichzeitig durchgeführt führten sie zu einem Langzeitüberleben von 81%. Eine Protheseninfektion nach initialem Aortenrepair mit alloplastischem Material (n = 40) entwickelte sich im Verlauf bei 10 Patienten (25%). Diskussion Die Diagnosestellung beruht auf der Probengewinnung jeglichen infizierten Gewebes und der Kombination aus passender Anamnese, Klinik und Laboranalysen. Die Kombination aus chirurgischer Infektsanierung und pharmakologischer Begleittherapie scheint die besten Ergebnisse zu erzielen. Bereits bei der Initialoperation sollte die Möglichkeit eines autologen oder allogenen Aortenersatzes evaluiert werden, da das Risiko eines Protheseninfektes nach Verwendung alloplastischer Materialien hoch ist.

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Mycotic Thoracic Aortic Aneurysm After Intravesical Bacillus Calmette–Guérin Treatment

Cited by 12 publications

References 7 publications

Complications of intravesical BCG therapy in non-muscle invasive bladder cancer: our tertiary care centre experience

Complications of intravesical BCG therapy in non-muscle invasive bladder cancer: our tertiary care centre experience

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

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