Cases reported "aneurysm, infected"

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1/754. Tuberculous mycotic aneurysm of the aorta: review of published medical and surgical experience.

    To define the epidemiology, pathogenesis, pathology, presentation, and management of tuberculous mycotic aneurysm of the aorta (TBAA) in the therapeutic era, we reviewed all of the cases reported in the English language literature from 1945 to the present. To the 39 cases in the published literature, we add two cases of our own. Although it is exceedingly rare, the prevalence of this lesion has remained relatively constant. In 75% of the cases, TBAA appeared to result from erosion of the aortic wall by a contiguous focus; 25% from direct seeding of the aortic intima or of the adventitia or media (via the vasa vasorum). Most of the aneurysms were saccular (90%) and false (88%). The thoracic and abdominal aortas were affected with equal frequency. The mean ( /- SD) age of the patients was 50 /-16 years. Twenty-two were men, and 19 were women. In 63% of the cases, tuberculosis (TB) was diagnosed at presentation. Disseminated TB was present in 46% of the cases. One or more of three clinical scenarios suggested TBAA: persistent pain, major bleeding, and a palpable or radiographically visible para-aortic mass, especially if it is expanding or pulsatile. In turn, each of these findings suggested a complication of TBAA that may be an indication for surgical intervention. Among the patients who were offered both medical and surgical treatment, 20 of 23 (87%) survived. Among those who were offered only one form of treatment or were offered no treatment at all there were no survivors. Both in situ reconstruction with a prosthetic graft, and extra-anatomic bypass appeared to offer excellent results, provided that an effective regimen of antituberculous drugs was delivered postoperatively. We offer our conclusions: (1) symptomatic TBAA is a rare but uniformly fatal lesion if not diagnosed promptly, (2) in the context of active TB, and especially miliary TB, TBAA should be suspected whenever one or more of the three clinical scenarios are present, and (3) combined medical and surgical therapy appears to offer the best chance of a cure. ( info)

2/754. Repair of a pseudoaneurysm of the ascending aorta after aortic valve replacement.

    An elderly woman underwent an aortic valve replacement and 5 months later developed a pseudoaneurysm from the anterior aspect of the proximal ascending aorta (AA). The pseudoaneurysm was approached through a redo-median sternotomy, on cardiopulmonary bypass (CPB), mild hypothermia, and a beating heart, with a temporary fingertip occlusion of its ostium, and repaired successfully using mattress monofilament sutures enforced by pledgets. The standard approach to such pseudoaneurysms is a CPB and hypothermic circulatory arrest (HCA) prior to mid-sternotomy, and replacement of the AA. But, when a pseudoaneurysm arises from a narrow ostium on the anterior aspect of the AA, as in this case, it can be sutured closed with pledgets under CPB with a mild hypothermia and a beating heart. ( info)

3/754. Embolic bacterial aneurysm of the basilar artery: case report.

    A patient with basilar artery rupture caused by a septic embolus originating from a mitral valve vegetation is reported. The pathogenesis, investigation and management of infected cerebral aneurysms are reviewed. ( info)

4/754. Mycotic aneurysms of the tibioperoneal arteries.

    This case report describes a pediatric patient with mycotic aneurysms of both posterior tibial arteries and the right peroneal artery associated with an episode of endocarditis. To our knowledge, this case represents the first reported occurrence of multiple mycotic aneurysms of the tibioperoneal arteries. It is also unique in that the pathogen was brucella canis instead of the usual gram-positive pathogens associated with intravenous drug injection. Vascular reconstruction can be accomplished; however, management of this complex problem should be individualized. ( info)

5/754. "True" mycotic aneurysm of a renal artery allograft.

    A 60-year-old white man sustained a rupture of the renal artery 6 weeks after a cadaveric kidney transplantation. The bleeding site was repaired, and culture of the hematoma showed an isolated growth of candida albicans. blood and urine cultures were negative. Systemic antifungal therapy was initiated. Bleeding from the renal artery recurred, eventually requiring removal of the transplanted kidney. Histopathology of the resected specimen showed budding yeast in the wall of the renal artery, but no evidence of fungal invasion of the kidney. The patient received 6 weeks of amphotericin b therapy and currently remains on hemodialysis therapy. ( info)

6/754. Mycotic aneurysm complicating staphylococcal endocarditis.

    OBJECTIVE: To emphasize the role of noninvasive diagnostic investigative methods and their importance in early detection of mycotic aneurysm related to staphylococcal endocarditis, and of monitoring therapy or identifying complications. patients AND methods: Two patients with mycotic aneurysm that developed as complications of staphylococcal endocarditis are presented. The first patient had mesenteric artery mycotic aneurysm and presented with sudden rupture one month after initial diagnosis of mitral valve infective endocarditis and completion of a full course of antimicrobial therapy. The second patient had multiple cerebral mycotic microaneurysms and presented with hemorrhagic cerebral embolization from aortic valve infective endocarditis. RESULTS: The first patient died because of ischemic cerebral edema 48 h after rupture of the mesenteric artery mycotic aneurysm and massive hemoperitoneum, which was treated surgically with distal ileal resection and ileostomy. The second patient was alive two years after prolonged antimicrobial therapy and aortic replacement to treat moderate aortic regurgitation and progressive left ventricular enlargement. CONCLUSIONS: Mycotic aneurysm is a rare complication of infective endocarditis but has a high mortality rate because of its early or late potential catastrophic rupture. diagnosis by noninvasive diagnostic imaging techniques of mycotic aneurysm before rupture would be beneficial for its treatment. ( info)

7/754. Endovascular treatment of ruptured, peripheral cerebral aneurysms: parent artery occlusion with short Guglielmi detachable coils.

    We report two cases of distal cerebral aneurysms that were treated by parent artery occlusion with short Guglielmi detachable coils (GDCs). One patient had a presumed mycotic aneurysm of the distal left posterior cerebral artery, and the other had a partially clipped aneurysm of the distal right anterior inferior cerebellar artery that had hemorrhaged. Short GDCs allow controlled, accurate occlusion of the parent artery at the aneurysmal neck. ( info)

8/754. Comparison of transesophageal to transthoracic color Doppler echocardiography in the identification of intracardiac mycotic aneurysms in infective endocarditis.

    We report on cases of mycotic aneurysms in a group of 14 patients with infective endocarditis, all of whom were evaluated with transthoracic (TTE) and transesophageal (TEE) color Doppler echocardiography. Four mycotic aneurysms were found, one each in the left ventricular outflow tract, the right coronary sinus of valsalva, the anterior mitral leaflet, and the atrial septum. With TTE, only three of four cases of mycotic aneurysms could be detected. Utilizing TEE, however, all were detected and their connections with the heart chambers or great vessels could be readily and clearly depicted, especially those in the atrial septum and mitral leaflet. We are of the opinion that TEE is superior to TTE in the identification and detailed analysis of mycotic aneurysms complicating infective endocarditis. In addition, we feel that echocardiography may help evaluate the progress of the disease, the location and direction of infection, and the extent of involvement of the mycotic aneurysms, providing useful information for guiding surgical intervention. ( info)

9/754. Video-assisted crossover iliofemoral obturator bypass grafting: a minimally invasive approach to extra-anatomic lower limb revascularization.

    Graft infection continues to be one of the most feared complications in vascular surgery. It can lead to disruption of anastomoses with life-threatening bleeding, thrombosis of the bypass graft, and systemic septic manifestations. One method to ensure adequate limb perfusion after removal of an infected aortofemoral graft is extra-anatomical bypass grafting. We used a minimally invasive, video-assisted approach to implant a crossover iliofemoral obturator bypass graft in a patient with infection of the left limb of an aortofemoral bifurcated graft. This appears to be the first case report describing the use of this technique. ( info)

10/754. 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. ( info)
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