Endovascular treatment of a ruptured thoracic aortic pseudoaneurysm secondary to Pott disease during a spine surgery

Abstract

Rationale: The coexistence of a tuberculous aortic pseudoaneurysm and Pott disease in patients with a history of tuberculosis (TB) is relatively rare, and the treatment strategies remain still controversial. Patient concerns: A 57-year-old female patient with a history of primary pulmonary TB presented with symptoms of breathlessness, chest pain, weight loss, and fever. Magnetic resonance imaging (MRI) and computed tomography (CT) showed a thoracic aortic pseudoaneurysm secondary to Pott disease at T11/12 level. Diagnoses: Tuberculous pseudoaneurysm at the descending thoracic aorta associated with tuberculous vertebral osteomyelitis. Interventions: We originally planned a combined surgery consisting of posterior spine stabilization, anterior excision of the infected field, and aortic reconstruction. When we surgically stabilized the posterior spine, unexpectedly, the pseudoaneurysm ruptured. Immediately, we terminated the surgery and appropriately placed an endovascular stent graft, which successfully rescued the patient. Outcomes: When the patient's conditions were stable, we anteriorly debrided all infected tissues and then performed a spinal fusion by grafting autologous iliac bone. After the debridement and spinal fusion, we arranged a 1-year anti-tuberculous chemotherapy for this patient and performed a 24-month follow-up. This patient had no signs of recurrent infection during the follow-up. Lessons: For the patients with tuberculous aortic aneurysm(s) complicated with vertebral osteomyelitis, the endovascular repair of an aneurysm(s) should be considered a conventional therapy before the spine surgery, lowering the risk of aortic aneurysm rupture. Meanwhile, minimally invasive endovascular stent graft combined with anti-tuberculosis drugs may be considered one of the therapeutic regimens for the patients whose conditions are not suitable for open surgery, such as age, weakness, or severe organ failure.

Tuberculous Aortic Aneurysm - A Review

“…Early recognition of aneurysms and prompt surgery by excision or grafting is found to be a prominent solution. The types of surgeries are debridement of the infected field with in situ prostheses, prosthetic grafting, extra-anatomic bypass, insertion of an aortic conduit, patch closure and direct closure [ 6 , 9 , 25 ] .…”

“…The patient underwent total arch replacement, started with a fixed dose of ATT and fully recovered. Endovascular stent graft implantation proved to be an ultimate option for TBAA treatment in a 79-year-old male from Thailand [ 25 , 40 ] . The patient underwent posterior decompressive laminectomy and showed a gradual improvement in motor power.…”

Tuberculous Thoracic Aortic Pseudoaneurysm Associated With Spinal Tuberculosis: A Case Report and Literature Review

“…Tuberculous pseudoaneurysm is a rare disease, and the case with spinal tuberculosis is even rarer. We reviewed previous literature from 1999 to the present and found 21 patients in 17 related literature with tuberculous pseudoaneurysm combined with spinal tuberculosis ( 2 – 18 ) ( Table 1 ).…”

Infected Aortic Aneurysm with Infective Spondylitis in a Patient with Pre-Aortic Confluence of the Iliac Veins: An Unusual Triple Combination

“…In comparison to open surgery, endovascular repair is associated with improved short-term outcomes [ 14 ]. For severely ill patients with coexisting spondylitis and infected aortic aneurysms, stent grafting and long-term antimicrobial therapy may be a more suitable option [ 15 ].…”