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• W1992053254 abstract "HomeCirculationVol. 117, No. 24Complications After Endoluminal Stent Grafting of a Thoracic Mycotic Aneurysm Free AccessReview ArticlePDF/EPUBAboutView PDFView EPUBSections ToolsAdd to favoritesDownload citationsTrack citationsPermissions ShareShare onFacebookTwitterLinked InMendeleyReddit Jump toFree AccessReview ArticlePDF/EPUBComplications After Endoluminal Stent Grafting of a Thoracic Mycotic Aneurysm Prakash Saha, MRCS, Kevin G. Burnand, MS, FRCS, Sanjay D. Patel, MRCS and Matt Waltham, MA, PhD, FRCS Prakash SahaPrakash Saha From the Academic Department of Surgery, King’s College London, London, UK. Search for more papers by this author , Kevin G. BurnandKevin G. Burnand From the Academic Department of Surgery, King’s College London, London, UK. Search for more papers by this author , Sanjay D. PatelSanjay D. Patel From the Academic Department of Surgery, King’s College London, London, UK. Search for more papers by this author and Matt WalthamMatt Waltham From the Academic Department of Surgery, King’s College London, London, UK. Search for more papers by this author Originally published17 Jun 2008https://doi.org/10.1161/CIRCULATIONAHA.107.743401Circulation. 2008;117:3157–3159A 64-year-old man collapsed and was admitted to our hospital. He had a 3-month history of diarrhea with occasional rectal bleeding, and prior stool cultures had grown Salmonella. His ECG demonstrated a sinus tachycardia (Figure 1). A gastroscopy showed extrinsic compression of the esophagus, and computed tomography with contrast revealed a saccular aneurysm of the descending thoracic aorta with circumferential thrombus (Figure 2). No significant mediastinal adenopathy was noted, and no pulmonary masses were identified. A mycotic aneurysm was suspected, and an endoluminal stent graft inserted. Download figureDownload PowerPointFigure 1. ECG showing sinus tachycardia.Download figureDownload PowerPointFigure 2. Saccular aneurysm (arrow) arising from the descending thoracic aorta, with circumferential thrombus lying in close proximity to the vertebral column.He recovered well, but had a hematemesis on postoperative day 38. A chest radiograph after the insertion of a central line demonstrated the stent graft in situ (Figure 3). Gastroscopy showed active bleeding within the esophagus and an on-table angiogram demonstrated a type 1 endoleak. A second endoluminal stent graft was inserted more proximally. A repeat gastroscopy, performed 1 week later, showed a 3-cm deficit in the mid-esophagus with a visible stent graft (Figure 4). Download figureDownload PowerPointFigure 3. Chest radiograph after central line insertion. The arrow indicates the endoluminal stent graft in situ.Download figureDownload PowerPointFigure 4. Gastroscopy showing a deficit in the esophagus with a visible endoluminal stent graft.On day 46, the patient became paraplegic. Computed tomography showed that the T7/T8 vertebral body had been destroyed by osteomyelitis (Figure 5). No surgical intervention was undertaken, and the patient died after a catastrophic bleed. Download figureDownload PowerPointFigure 5. Contrast-enhanced computed tomography showing the endoluminal stent graft (A), with lytic destruction of vertebral bodies (B). There is air surrounding the graft (C), suggesting an on-going infective process.The present case highlights the potential complications that may arise from endoluminal stent grafting of a mycotic aneurysm. A rare condition, it is estimated to account for 0.85% of all aortic aneurysms. Open repair with excision of the aneurysm and debridement of the surrounding infected inflammatory tissue followed by either in situ repair or extra-anatomic bypass is associated with significant increases in rates of morbidity and mortality.1 Furthermore, the general condition of the patient frequently precludes any attempt at open repair.2 Stent grafting has been advocated for the treatment of this condition, with a number of reports confirming the feasibility of an endoluminal approach. Midterm results compare well against those seen with open repair.2–4 As these images show, however, endoluminal stenting will not provide curative treatment if the local tissues are heavily infected. Endovascular treatment with concurrent antibiotics may be only palliative.DisclosuresNone.FootnotesCorrespondence to Prakash Saha, Academic Department of Surgery, Cardiovascular Division, King’s College London, 1st Floor North Wing, St Thomas’ Hospital, Westminster Bridge Road, London, SE1 7EH, United Kingdom. E-mail [email protected]References1 Müller BT, Wegener OR, Grabitz K, Pillny M, Thomas L, Sandmann W. Mycotic aneurysms of the thoracic and abdominal aorta and iliac arteries: experience with anatomic and extra-anatomic repair in 33 cases. J Vasc Surg. 2001; 33: 106–113.CrossrefMedlineGoogle Scholar2 Chan YC, Morales JP, Taylor PR. The management of mycotic aortic aneurysms: is there a role for endoluminal treatment? Acta Chir Belg. 2005; 105: 580–587.CrossrefMedlineGoogle Scholar3 Jones KG, Bell RE, Sabharwal T, Aukett M, Reidy JF, Taylor PR. Treatment of mycotic aortic aneurysms with endoluminal grafts. Eur J Vasc Endovasc Surg. 2005; 29: 139–144.CrossrefMedlineGoogle Scholar4 Kyriakides C, Kan Y, Kerle M, Cheshire NJ, Mansfield AO, Wolfe JH. 11-year experience with anatomical and extra-anatomical repair of mycotic aortic aneurysms. Eur J Vasc Endovasc Surg. 2004; 27: 585–589.CrossrefMedlineGoogle Scholar Previous Back to top Next FiguresReferencesRelatedDetails June 17, 2008Vol 117, Issue 24 Advertisement Article InformationMetrics https://doi.org/10.1161/CIRCULATIONAHA.107.743401PMID: 18559716 Originally publishedJune 17, 2008 PDF download Advertisement SubjectsCardiovascular Surgery" @default.
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