Infected Aneurysm: Current Management

Kim, Young-wook

doi:10.3400/avd.cr09015

Cited by 63 publications

(50 citation statements)

References 31 publications

(26 reference statements)

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“…Dentro de los hallazgos radiológicos para identificar un aneurisma infeccioso están una pared aórtica irregular, signos inflamatorios o masa alrededor del vaso, aneurisma con aire intramural o colección aérea alrededor del vaso, colección líquida perivascular y formación sacular, excéntrica o multilobulada 6 . Si el diagnóstico aun así no es claro deben realizarse escáneres seriados en un corto periodo para evaluar la presencia de crecimiento rápido sugerente de infección 5,7 .…”

Section: Discussionunclassified

“…Esta última presenta el inconveniente de menor permeabilidad que la revascularización anatómica y si optamos por revascularizar in situ, realizaremos una anastomosis vascular en un lecho infectado, lo que implica riesgo de ruptura por dehiscencia de sutura o falso aneurisma. Aún así, sigue siendo una opción válida para aquellos casos donde el aneurisma infeccioso es relativamente accesible fácilmente en cirugía abierta, como por ejemplo, a nivel iliaco 1,2,5,8 .…”

Section: Discussionunclassified

“…Los aneurismas infecciosos constituyen una patología poco frecuente, entre el 1 y 3% 1,2 de todos los aneurismas, y corresponden a aquellos que presentan infección de la pared del vaso implicado que conlleva a la destrucción de ésta debido a la proliferación bacteriana formando así el aneurisma 3,4 . Por su etiopatogenia se encuentran con mayor frecuencia en enfermos inmunodeprimidos o con sepsis coexistente 1,5 .…”

Section: Introduccionunclassified

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Manejo De Un Aneurisma Infeccioso

et al. 2019

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Introduction: Infectious aneurysms are a rare disease and are characterized by infection of the involved vessel wall. The best treatment is definitely not established. Aim: To describe a case of infectious aneurysm with endovascular management. Case report: We present a 75-year-old male patient admitted to a table compatible with acute abdomen and that an infectious aneurysm of the celiac trunk is investigated in the postoperative period, treated with an endoprosthesis and antibiotic management. Discussion: The traditional management of the infectious aneurysm is open surgery that includes the removal or exclusion of the aneurysm and its infected perivascular tissue, but it leads to great morbidity and mortality. Conclusion: The infectious aneurysm can be managed minimally invasively with endovascular technique, with immediate low morbidity, but with long-term results that are still inconclusive.

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Manejo De Un Aneurisma Infeccioso

et al. 2019

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“…Contiguous aortitis usually occurs due to an adjacent infective focus such an infected vertebral body or a psoas abscess. 6) Contrary to an infected peripheral artery, aortitis presents with non-specific signs and symptoms leading to a delay in diagnosis. 6) Although cultures revealed negative results, an infected aneurysm could not be overlooked.…”

Section: Resultsmentioning

confidence: 99%

“…6) Contrary to an infected peripheral artery, aortitis presents with non-specific signs and symptoms leading to a delay in diagnosis. 6) Although cultures revealed negative results, an infected aneurysm could not be overlooked. The deterioration of our patient's clinical state along with the increase in aneurysm size (1 cm in 3 months) demanded urgent intervention.…”

Section: Resultsmentioning

confidence: 99%

Chronic Contained Abdominal Aortic Aneurysm Rupture Mimicking Vertebral Spondylodiscitis: A Case Report

Alshafei¹,

Kamal²

2015

Annals of Vascular Diseases

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radiological evidence of vertebral spondylodiscitis and a psoas collection that was presumed to be secondary to an infective process. These radiological findings were subsequently found to be due to a contained AAA rupture with no signs of sepsis intra-operatively.Fortunately, the delay in diagnosis did not alter the long-term outcome and the patient recovered well after appropriate surgical management. Case ReportWe report a case of a 63-year-old Caucasian male who is a chronic smoker, hypertensive, and dyslipidemic. He was presented with a 4-month history of low back pain and a 1-year history of limiting bilateral intermittent claudication. On examination, he had a pulsatile expansile abdominal mass with absent femoral and distal pulses. The anklebrachial index was 0.61 on the right and 0.46 on the left with no distal tissue loss. The rest of the examination was otherwise unremarkable with good cardiac and respiratory status. Further lab workup including a complete blood count, renal function, liver function, coagulation profile, and erythrocyte sedimentation rate (ESR) were normal except for an elevated C-reactive protein (CRP) of 26.The initial CT aortogram showed a 4 cm infra-renal AAA (Fig. 1). Visualization of the common iliac arteries revealed tight stenosis and focal occlusion on the right and left side respectively. In addition, a right-sided 5 cm × 2.8 cm psoas muscle collection was evident along with erosion of the L4 vertebrae (Fig. 2). A lumbar spine MRI confirmed this collection and showed evidence of spondylodiscitis at L4-L5 manifested by erosive vertebral changes.Our provisional diagnosis was therefore spondylodiscitis at L4-L5 complicated by vertebral erosion and a psoas abscess. Although it was suspected, whether or not the aorta was involved in the infective process or even ruptured with a contained hematoma was a question yet to be answered.With these findings in mind, the patient was immediately referred to our infectious disease and neurosurgery service that opted to treat the spine infection non-operatively and obtain a CT-guided aspirate of the psoas collection.A 63-year-old Caucasian male presented with a 4-month history of low back pain associated with bilateral intermittent claudication. A contrast enhanced CT scan demonstrated a 4 cm abdominal aortic aneurysm (AAA), along with severe bilateral aorto-iliac disease, a right psoas collection, and extensive vertebral erosion. An MRI of the lumbar spine suggested spondylodiscitis at L4-L5. After an unsuccessful and prolonged course of antibiotics, a decision was ultimately made to repair the aneurysm and bypass the aorto-iliac disease. Intra-operatively, a chronic contained rupture (CCR) involving the posterior aortic wall was encountered and repaired with an aorto-bifemoral bypass graft.

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Association Between Fluoroquinolone Use and Hospitalization With Aortic Aneurysm or Aortic Dissection

et al. 2023

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ImportanceFluoroquinolone use has been associated with increased hospitalization with aortic aneurysm or dissection in noninterventional studies, but the reason for this observed association is unclear.ObjectiveTo determine the association between fluoroquinolone use and aortic aneurysm or dissection using multiple study designs and multiple databases to increase the robustness of findings.Design, Setting, and ParticipantsCohort and case-crossover studies were conducted separately in 2 databases of UK primary care records. Clinical Practice Research Datalink Aurum and GOLD primary care records were linked to hospital admissions data. Adults with a systemic fluoroquinolone or cephalosporin prescription between April 1997 and December 2019 were included in the cohort study. Adults hospitalized with aortic aneurysm or dissection within the eligibility period were included in the case-crossover study. Individuals meeting inclusion criteria in the case-crossover study were matched 1:3 to control individuals on age, sex, index date, and clinical practice to adjust for calendar trends in prescribing. Data were analyzed from January to July 2022.ExposuresSystemic fluoroquinolone or comparator antibiotic.Main Outcomes and MeasuresHazard ratios (HRs) were estimated in the cohort study for the association between prescription of fluoroquinolones and hospitalization with aortic aneurysm or dissection using stabilized inverse probability of treatment-weighted Cox regression. Odds ratios (OR) were estimated in the case-crossover study for the association between systemic fluoroquinolone use and hospitalization with aortic aneurysm or dissection using a conditional logistic regression model. Estimates were pooled across databases using fixed-effects meta-analysis.ResultsIn the cohort study, we identified 3 134 121 adults in Aurum (mean [SD] age, 52.5 [20.3] years; 1 969 257 [62.8%] female) and 452 086 in GOLD (mean [SD] age, 53.9 [20.2] years; 286 502 [63.4%] female) who were prescribed fluoroquinolones or cephalosporins. In crude analyses, fluoroquinolone relative to cephalosporin use was associated with increased hospitalization with aortic aneurysm or dissection (pooled HR, 1.28; 95% CI, 1.13-1.44; P &lt; .001) but after adjustment for potential confounders, this association disappeared (pooled adjusted HR, 1.03; 95% CI, 0.91-1.17; P = .65). In the case-crossover study, we identified 84 841 individuals hospitalized with aortic aneurysm or dissection in Aurum (mean [SD] age, 75.5 [10.9]; 23 551 [27.8%] female) and 10 357 in GOLD (mean [SD] age, 75.6 [10.5]; 2809 [27.1%] female). Relative to nonuse, fluoroquinolone use was associated with an increase in hospitalization with aortic aneurysm or dissection, but no association was found relative to other antibiotics (vs cephalosporin pooled OR, 1.05; 95% CI, 0.87-1.27; vs trimethoprim, 0.89; 95% CI, 0.75-1.06; vs co-amoxiclav, 0.98; 95% CI, 0.82-1.18).Conclusions and RelevanceThe results in this study suggest that estimates of association of fluoroquinolones with aortic aneurysm or dissection may be affected by confounding. When such confounding is accounted for, no association was evident, providing reassurance on the safety of fluoroquinolones with respect to aortic aneurysm or dissection.

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Infected Aneurysm: Current Management

Cited by 63 publications

References 31 publications

Manejo De Un Aneurisma Infeccioso

Manejo De Un Aneurisma Infeccioso

Chronic Contained Abdominal Aortic Aneurysm Rupture Mimicking Vertebral Spondylodiscitis: A Case Report

Association Between Fluoroquinolone Use and Hospitalization With Aortic Aneurysm or Aortic Dissection

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