Diagnosis and Management of Aortic Mycotic Aneurysms

Abstract

We reviewed all papers most recently reported in the literature (January-December 2008) with regard to infected arterial aneurysms (IAAs) affecting the aorta. Most of the recently reported knowledge is limited to case reports and small series of aortic mycotic aneurysms. Most patients are elderly men and have comorbidities at presentation. Aneurysms were most commonly associated to Salmonella and Staphylococcus. However, several cases of aortic IAAs caused by atypical pathogens were also reported, likely due to an increase in immunosuppressive illnesses, increased life expectancy, improved diagnostic methods, and increasing medical awareness. Open surgical therapy of IAAs remains the gold standard. Some have reported successful outcomes with endovascular methodologies for patients medically compromised or for particular challenging clinical or anatomical scenarios. However, at this time, conclusive evidence is lacking and it should be in general considered a bridge to open repair. The latter should be planned at the earliest possible, when medically permissible.

Mycotic aneurysm caused by Burkholderia pseudomallei: report of a Brazilian strain genetically related to Thai strains

“…In a study of infected aortic aneurysms (80% in men, with average age of 63 years) in an endemic area for melioidosis, the most common comorbidities were hypertension and renal disease. Burkholderia pseudomallei was the most commonly isolated pathogen (42.5%) and the abdominal aorta was the most frequently involved artery (87.5%), followed by the thoracic aorta, common iliac arteries and superficial femoral arteries [3].…”

Rare Mycotic Aneurysm of the Mitral Valve without Aortic Valve Involvement

“…8,9 Gram-positive bacteria are the predominant bacterial class implicated in MA, with the primary organisms being staphylococcal species, or streptococcal species as in our case. 10 Among the imaging options available to diagnose valvular MA, TEE is the ideal modality, as it has higher sensitivity for assessing MV leaflet morphology than TTE. 4 Three-dimensional TEE was useful for diagnosing the MV aneurysm in this case, as it allowed for further MV visualization, the ballooning of the aneurysm during systole, and its collapse during diastole.…”

Bridging Endovascular Therapy and Subsequent Surgical Repair for the Treatment of Infected Aneurysms after Percutaneous Cardiac Intervention

“…On the other hand, endovascular treatment gives the option to treat the aneurysm by minimizing periprocedural complications. Although there have been reports of endovascular repair as the only and definite treatment for infected aneurysms, it is not widely suggested [3]. The infected arterial tissue remains in place and in touch with the endograft, and may predispose to the relapse of the infection.…”