1/27. Primary aorto-duodenal fistula secondary to infected abdominal aortic aneurysms: the role of local debridement and extra-anatomic bypass.Gastrointestinal bleeding secondary to spontaneous rupture of an infected abdominal aortic aneurysm into the duodenum is a rare and highly lethal clinical occurrence, representing roughly a third of all primary aortoduodenal fistulas. diagnosis is problematic due to the subtleties in the clinical presentation and course, and surgical treatment is usually delayed, representing a challenge even for the experienced vascular surgeon. The overall mortality is over 30% and the operative approaches are still controversial. Two cases of ruptured infrarenal aortic aneurysms complicated with aortoduodenal fistula were recently treated at our institution. Bacterial aortitis was documented by arterial wall cultures positive for klebsiella and salmonella species respectively. The clinical courses and outcomes of the two patients (one survivor ) treated with retroperitoneal debridement and extra-anatomic bypass and a review of the modern surgical treatment are herein described.- - - - - - - - - - ranking = 1keywords = aortitis (Clic here for more details about this article) |
2/27. Cryptococcal aortitis presenting as a ruptured mycotic abdominal aortic aneurysm.Mycotic processes occasionally complicate atherosclerotic aortic disease and usually require aggressive surgical therapy to control sepsis and prevent arterial rupture. Rarely, fungal organisms are responsible for primary infection of the abdominal aorta. We report the first case of Cryptococcal aortitis presenting as a ruptured abdominal aortic aneurysm. The surgical, pathologic, and microbiologic aspects of fungal aortitis are discussed.- - - - - - - - - - ranking = 6keywords = aortitis (Clic here for more details about this article) |
3/27. Mycotic pseudoaneurysm of the aorta in children.Mycotic pseudoaneurysm of the aorta is a rare disease in childhood. We report on two cases which were diagnosed in an unselected general pediatric population within an 8-month period. The first case was a 16-month-old toddler with a normal cardiac history who presented with purulent pericarditis due to group A streptococcus and subsequent pseudoaneurysm formation of the ascending aorta while convalescing from varicella infection. The second case was a 14-year-old girl with a previously undiagnosed coarctation of the aorta who developed a staphylococcus aureus aortitis in the dilated poststenotic segment with pseudoaneurysm formation and infiltration into the adjacent lung tissue. In both cases parenteral antibiotic therapy was administered over 10 and 4 days, respectively, followed by emergency surgery consisting of aneurysmectomy, coarctectomy (case 2), and in situ homograft implantation. Recovery was uneventful. In both cases early institution of a femorofemoral cardiopulmonary bypass prevented a fatal outcome despite intraoperative rupture of the pseudoaneurysm.- - - - - - - - - - ranking = 1keywords = aortitis (Clic here for more details about this article) |
4/27. Primary repair with in-situ interposition graft for infrarenal mycotic aortic pseudoaneurysm.This is a case report of a pseudoaneurysm due to salmonella aortitis in a 52 year old man. The condition is rare and represents one of the few cases reported in malaysia. The diagnosis was made preoperatively by ultrasonography and computed tomography. This was confirmed at surgery where there was a 3 cm defect at the posterior wall of the aorta at L2/3 level. The aneurysmal sac extended to the retrocrural space at the 12th vertebra level cranially on the right side to the lower border of the 3rd lumbar vertebra caudally. It had a smooth fibrous wall and contained a mixture of organised haematoma and pus. At operation the aneurysm was excised, the affected region was carefully debrided and the aorta grafted with an in-situ in-lay graft. Antibiotic therapy was instituted until clinical response was evident, leukocytosis was reduced and blood culture was negative. However 4 months after surgery, the patient returned in irreversible shock and succumbed to disseminated intravascular coagulation secondary to massive upper gastrointestinal haemorrhage from an aortoduodenal fistula.- - - - - - - - - - ranking = 1keywords = aortitis (Clic here for more details about this article) |
5/27. Mycotic aneurysms of the aorta caused by infection with pasteurella multocida.We evaluated a patient for mycotic aneurysms caused by pasteurella multocida. We treated Pasteurella aortitis medically with ciprofloxacin, and the patient has had long-term survival.- - - - - - - - - - ranking = 1keywords = aortitis (Clic here for more details about this article) |
6/27. Tuberculous aneurysm of the aorta presenting with uncontrolled hypertension.Mycotic aneurysm secondary to tuberculous infection of the aorta is a rare entity with less than 50 cases having been described in the literature. Clinical presentation is usually a consequence of the aneurysm, including pain, palpable mass, or hypovolemia secondary to leak. Definitive treatment is surgical, with nearly 30 documented successful cases. The authors present a case of tuberculous aortitis with mycotic aneurysms that presented with uncontrolled hypertension and occlusion of the right renal artery that underwent successful surgical repair.- - - - - - - - - - ranking = 1keywords = aortitis (Clic here for more details about this article) |
7/27. Rapid progression of bacterial aortitis to an ascending aortic mycotic aneurysm documented by transesophageal echocardiography.A case of bacterial aortitis of the ascending aorta caused by staphylococcus aureus progressed to an aortic mycotic aneurysm. Transesophageal echocardiography was the diagnostic approach of choice. The different stages of the disease from the initial aortic wall infection to formation of an abscess that communicated with the aortic lumen were documented by transesophageal echocardiography.- - - - - - - - - - ranking = 5keywords = aortitis (Clic here for more details about this article) |
8/27. Fatal salmonella aortitis with mycotic aneurysm rupture.Salmonellae most commonly cause uncomplicated cases of gastroenteritis but have a predilection for damaged blood vessels, especially those damaged by atherosclerosis. The abdominal aorta is most frequently affected. The most serious complication of aortitis is mycotic aneurysm formation with subsequent rupture. The authors present the case of a 61-year-old man who was found unresponsive at home 3 days after discharge from the hospital for treatment of gastroenteritis with bacteremia. Postmortem examination revealed a ruptured mycotic aneurysm with a large retroperitoneal hematoma. Numerous gram-negative rods were embedded in the wall of the aorta and surrounding inflammatory infiltrate, compatible with the patient's previously isolated. Whereas abdominal aortic aneurysm rupture is most commonly associated with atherosclerosis, the isolation of from blood cultures, coupled with radiographic evidence of gas surrounding the aorta, should raise the suspicion of infectious aortitis. Whereas fatal rupture of an aortic aneurysm secondary to atherosclerosis alone or in conjunction with aortitis will not have an impact on the manner of death, infections are reportable and thus have public health implications.- - - - - - - - - - ranking = 7keywords = aortitis (Clic here for more details about this article) |
9/27. Mycotic aneurysm caused by burkholderia pseudomallei with negative blood cultures.We describe a case of bacterial aortitis caused by burkholderia pseudomallei. This patient presented with prolonged fever and hoarseness of voice. Aneurysm removal with Dacron graft replacement was performed, followed by a prolonged course of antibiotics. The patient has progressed satisfactorily without recurrence of symptoms. Previous case reports are summarized.- - - - - - - - - - ranking = 1keywords = aortitis (Clic here for more details about this article) |
10/27. Mycotic aneurysm of the abdominal aorta with retroperitoneal abscess: successful endovascular repair.Mycotic aortic aneurysms are rare. Improved diagnostic procedures, appropriate antibiotic treatment, and safe surgical techniques have reduced the high mortality associated with bacterial aortitis. However, definite evidence-based conclusions with regard to the surgical strategy cannot be drawn from the data available in the published literature. We report successful endovascular repair of a mycotic abdominal aortic aneurysm. Endovascular treatment may offer a benefit, especially in critically ill patients.- - - - - - - - - - ranking = 1keywords = aortitis (Clic here for more details about this article) |
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