Arterial Infections in the New Millenium: An Old Problem Revisited

McCready, Robert A.; Bryant, M. Ann; Divelbiss, Janet L.; Chess, Bart A.; Chitwood, Richard W.; Paget, Douglas S.

doi:10.1007/s10016-006-9107-y

Cited by 65 publications

(55 citation statements)

References 24 publications

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“…Although most mycotic aneurysms occur in the aorta, they have also been described in other sites like the iliac, femoral, splenic, gastroduodenal, renal, mesenteric, and the hepatic arteries [8][9][10][11]. Infective endocarditis, urinary tract infection, renal carcinoma, Crohn's disease, tuberculosis, and umbilical artery catheterization have been reported as various sources of infection leading on to the development of mycotic aneurysms [12][13][14][15].…”

Section: Discussionmentioning

confidence: 99%

Post–liver transplant mycotic aneurysm of the hepatic artery

Jones¹,

Chennapragada²,

Lord³

et al. 2008

Journal of Pediatric Surgery

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Section: Discussionmentioning

confidence: 99%

Post–liver transplant mycotic aneurysm of the hepatic artery

Jones¹,

Chennapragada²,

Lord³

et al. 2008

Journal of Pediatric Surgery

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“…Mycotic aneurysms are more likely to occur in the aorta than other arteries (6)(7)(8). Previously, MAs were associated with endocarditis, β-hemolytic group A streptococci, pneumococci, and Haemophilus influenza (8,9).…”

Section: Mycotic Aneurysmsmentioning

confidence: 99%

“…Rapid diagnosis and treatment is key, as aortic MA is associated with 15-50% mortality (7)(8)(9)24). No randomized trials are available to guide management, though treatment involves antibiotics and surgical intervention.…”

Section: Treatment and Prognosismentioning

confidence: 99%

Inflammatory and infectious aortic diseases

Deipolyi

Czaplicki

Öklü

2018

Cardiovasc. Diagn. Ther.

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Aortitis is aortic inflammation, which can be due to inflammatory or infectious diseases. Left undiagnosed, aortitis can lead to aneurysm formation and rupture, in addition to ischemic compromise of major organs. Infectious aortic diseases include mycotic aneurysm and graft infection; the most common inflammatory diseases are Takayasu's and giant cell arteritis. We review the epidemiology, etiology, presentation and diagnosis, and treatment of these entities. S62infectious extravascular source adjacent the arterial wall (16,17). Bacteria may seed the arterial wall injury either from bacteremia or septic emboli (18). Typically, infection initiates in a nidus such as in an ulcerated atherosclerotic plaque or in the vasa vasorum (12). The vasa vasorum is thought to be key in the pathogenesis of MA formation; due to its small lumen size and slower flow, it is more susceptible to bacterial colonization (19,20). The vasa vasorum is more pronounced in larger arteries, which may explain why the aorta is the most common site of MA formation. DiagnosisEarly diagnosis and rapid triage for intervention is key to reducing mortality from MA (21,22). However, diagnosis is challenging given the low prevalence and nonspecific symptoms. Clinical signs may include fever and laboratory abnormalities including elevated erythrocyte sedimentation rate and leukocytosis (23). Bacteremia is common, though cultures may be negative, particularly after antibiotics have been given. Symptoms include pain or a pulsatile mass (23). In the setting of pre-existing endocarditis, prior invasive procedures, intravenous drug use or immunocompromise should increase suspicion (8,24).Non-invasive cross-sectional imaging is essential in the diagnosis of MA. Computed tomography angiography (CTA) has arisen as the imaging modality of choice owing to its excellent resolution allowing for three-dimensional reconstruction and its rapid acquisition; magnetic resonance imaging (MRI) may also be used (25)(26)(27). Certain features may distinguish MA from non-infected aneurysms, including serial imaging which may reveal rapid progression typical of infected aneurysms. Other characteristic features include contrast-enhancement and a saccular outpouching configuration, whereas non-infected atherosclerotic aneurysms tend to be fusiform (28). Saccular configuration may also suggest imminent rupture, alerting the need for further urgent diagnostic workup. Other features include irregularity of the arterial wall and peri-aortic gas, edema, mass or stranding (28). MAs also tend to have higher uptake on FDG-PET imaging of 4.5 SUV max or more compared with non-infected aneurysms (29). FDG-PET boasts high sensitivity and its potentially high false-positive rate can be improved with simultaneous CT. Treatment and prognosisDue to its elusive presentation, MA is often difficult to treat because of delayed diagnosis. Rapid diagnosis and treatment is key, as aortic MA is associated with 15-50% mortality (7)(8)(9)24). No randomized trials are available to guide manage...

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“…The literature suggests that infected aneurysms tend to be within the distal arterial bed and hence are peripherally located or lie within the parenchyma of the involved organ [17,18]. Infected aneurysms are uncommon but can affect any artery [12,19,20]. Staphylococcus and Streptococcus species are the most common causes of infected aneurysms [21][22][23][24].…”

Section: Discussionmentioning

confidence: 97%