The treatment of tuberculous aortic pseudoaneurysm

Abstract

Objective: Our aim was to compare the outcomes of tuberculous aortic aneurysms treated with endovascular aortic repair (TEVAR) or open surgery. Methods: An electronic search of the National Library of Medicine PubMed database for tuberculous aortic aneurysm was performed between January 1998 through December 2017. Cases were screened for completeness of information and outcomes were recorded and analyzed. Results: A total of 56 studies were reviewed, with 61 (20 TEVAR, 41 open surgical repair) having adequate case details and follow-up. The in-hospital/30-day mortality was 0% (0 out of 20) in the TEVAR group and 7% (three out of 41) in the open surgery group (P = .54). Overall mortality was 5% (1/20) in the TEVAR group and 10% (4/41) in the open surgery group (P = .53). Two-year survival and freedom from aneurysm recurrence were comparable in the two groups, P = .45 and P = .94, respectively. One patient in the TEVAR group and one patient in the open surgery group died due to a rupture of a recurrent aortic aneurysm 16 and 28 months after surgery, respectively. Conclusions: TEVAR and anti-tuberculosis (TB) medications are reasonable initial treatment options for tuberculous aortic aneurysm especially in high-risk patients; however, careful follow-up is necessary. K E Y W O R D S endovascular repair, open surgery, tuberculous aortic pseudoaneurysm

Tuberculous Thoracic Aortic Pseudoaneurysm Associated With Spinal Tuberculosis: A Case Report and Literature Review

“…Open surgery has always been the gold standard for the treatment of tuberculous pseudoaneurysm, but recently EVAR has been widely used as an alternative to open surgery ( 14 , 15 ). In particular, the use of EVAR avoids a large incision, cardiopulmonary bypass, aortic cross-clamping, negative effects on respiratory function, and transfusions ( 25 ). However, EVAR is also associated with certain disadvantages, such as infection at the transplantation site, late prosthesis rupture, and embolism ( 5 ).…”

Endovascular treatment of a tuberculous aneurysm of the pararenal abdominal aorta leading to an aortoduodenal fistula

“…Pathological autopsy revealed accumulation of Mycobacterium tuberculosis in the cystic mass, which thrombosed and showed a tendency to shrink on the follow-up CT scans, leading to the diagnosis of a tuberculous mass. Infectious aortic aneurysms are reported 1 , 2 , 3 , 4 , 5 to account for approximately 3% of all aortic aneurysms, and infectious aortic aneurysms caused by M tuberculosis are extremely rare. According to the report by Volini et al, 6 there are two possible mechanisms for the development of tuberculous aortic aneurysms: (1) a direct invasion of the aortic wall from a tuberculous lesion such as in a lymph node or bone and an abscess around the aorta or (2) hematogenous spillover into the aortic feeding vessels or damaged aortic intima.…”

“…However, the cause of the infection may not be identified. Although there have been reports of good results with endovascular treatment of tuberculous aortic aneurysms, 1 , 2 , 3 , 4 the importance of antituberculosis drugs after an endovascular treatment has been highlighted. As for the surgical technique, in this case, reconstruction of the right and left renal arteries was performed using VIABAHN (covered stent) and a bare metal stent, in addition to the usual abdominal aortic stent graft.…”

Addressing the Challenges of Imaging in Tuberculosis: Need of the Hour

“…Aortic pseudoaneurysms have also been reported as a consequence of spinal TB. 15 The most common performed vascular procedure in patients with PTLD is bronchial artery embolization (BAE), performed in patients presenting with hemoptysis due to hypertrophied arteries. 16 In TB endemic regions, PTLD with or without CPA is the dominant indication of BAE, unlike the nonendemic regions where it is bronchiectasis.…”