Mycotic Celiac Artery Aneurysm Following Infective Endocarditis: Successful Treatment Using N-butyl Cyanoacrylate with Embolization Coils

Aki, Akira; Ueda, Toshihiko; Koizumi, Jun; Cho, Yoshinori; Shimura, Shinichiro; Furuya, Hidekazu; Myojin, Kazunori; Okada, Kazutaka; Tanaka, Chiharu

doi:10.3400/avd.cr.11.00052

Cited by 7 publications

(15 citation statements)

References 10 publications

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“…Although some resolved with this approach, 11 , 18 , 61 PMAs can enlarge, rupture, or cause complications as late as 3–9 months after ending antibiotic treatment. 2 , 46 , 63 The outcome of our patient with Bartonella henselae IE is remarkable because he developed a new peripheral SPMA in the popliteal vein 4 years later, after the cure of the intracranial SPMA. Although it is possible that this PMA was already present 4 years before and it was not recognized until it fistulized to the arterial vein, the elevation of the serology titers, when previously they had become negative, arouses doubt that a persistent endothelial infection became symptomatic later.…”

Section: Discussionmentioning

confidence: 81%

“…Extracranial PMAs have been associated with a high mortality rate. 4 Conservative treatment with antibiotics has been considered only in a minority of patients with intraabdominal 2 , 11 , 18 , 61 or coronary 46 PMAs. Although some resolved with this approach, 11 , 18 , 61 PMAs can enlarge, rupture, or cause complications as late as 3–9 months after ending antibiotic treatment.…”

Section: Discussionmentioning

confidence: 99%

“…Peripheral mycotic aneurysms (PMAs) in infective endocarditis (IE) result from septic embolization of vegetations to the arterial vasa vasorum with subsequent spread of infection throughout the vessel wall. 44 They are mainly located in the branches of intracranial arteries, 4 but have also been described in intraabdominal arteries, 2 , 3 , 18 , 25 – 27 , 35 , 41 , 43 , 56 , 61 , 63 coronary arteries, 39 , 46 , 47 , 54 , 62 and limbs. 6 , 17 , 19 , 24 , 30 , 32 , 33 , 37 , 40 , 45 , 48 , 52 , 57 , 58 …”

Section: Introductionmentioning

confidence: 99%

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Symptomatic Peripheral Mycotic Aneurysms Due to Infective Endocarditis

et al. 2014

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Peripheral mycotic aneurysms (PMAs) are a relatively rare but serious complication of infective endocarditis (IE). We conducted the current study to describe and compare the current epidemiologic, microbiologic, clinical, diagnostic, therapeutic, and prognostic characteristics of patients with symptomatic PMAs (SPMAs). A descriptive, comparative, retrospective observational study was performed in 3 tertiary hospitals, which are reference centers for cardiac surgery. From 922 definite IE episodes collected from 1996 to 2011, 18 patients (1.9%) had SPMAs. Because all SPMAs developed in left-sided IE, we performed a comparative study between 719 episodes of left-sided IE without SPMAs and 18 episodes with SPMAs.We found a higher frequency of intravenous drug abuse, native valve IE, intracranial bleeding, septic emboli, multiple embolisms, and IE diagnostic delay >30 days in patients with SPMAs than in patients without SPMAs. The causal microorganisms were gram-positive cocci (n =10), gram-negative bacilli (n = 2), gram-positive bacilli (n = 3), Bartonella henselae (n = 1), Candida albicans (n = 1), and negative culture (n = 1). The median IE diagnosis delay was 15 days (interquartile range [IQR], 13–33 d) in the case of high-virulence microorganisms versus 45 days (IQR, 30–240 d) in the case of low- to medium-virulence microorganisms. Twelve SPMAs were intracranial and 6 were extracranial. In 10 cases (8 intracranial and 2 extracranial), SPMAs were the initial presentation of IE; the remaining cases developed symptoms during or after finishing parenteral antibiotic treatment. The initial diagnosis of intracranial SPMAs was made by computed tomography (CT) or magnetic resonance imaging in 6 unruptured aneurysms and by angiography in 6 ruptured aneurysms. The initial test in extracranial SPMAs was Doppler ultrasonography in limbs, CT in liver, and coronary angiography in heart. Four (3 intracranial, 1 extracranial) of 7 (6 intracranial, 1 extracranial) patients treated only with antibiotics died. Surgical resection was performed in 7 (3 intracranial, 4 extracranial) and endovascular repair in 4 (3 intracranial, 1 extracranial) patients; all of them survived.In conclusion, we found that SPMAs were a rare complication of IE that developed only in left-sided IE, and especially in native valves. Intracranial hemorrhage, embolism, multiple embolisms, and diagnostic delay of IE were more common in patients with SPMAs. The microbiologic profile was diverse, but microorganisms of low-medium virulence were predominant, and had a greater delayed diagnosis of IE than those caused by microorganisms of high virulence. SPMAs were often the initial presentation of IE. The most common location of SPMAs was intracranial. Noninvasive radiologic imaging techniques were the initial imaging test in intracranial unruptured SPMAs and in most extracranial SPMAs. Surgical and endovascular treatments were safe and effective. Endovascular treatment could be the first line of treatment in selected cases. Mortality was high in those cases...

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Section: Discussionmentioning

confidence: 81%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Symptomatic Peripheral Mycotic Aneurysms Due to Infective Endocarditis

et al. 2014

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“…Mycotic aneurysm in the celiac artery is extremely rare: 1 patient was treated with endovascular therapy 8 months after infected valve replacement and the other 4 were treated with open surgery. [2][3][4][5][6] Radical resection of aneurysms is standard therapy, but endovascular embolization was chosen in the present case, because of the high risk of surgical resection in multiple aneurysms within the celiac artery, and because of the requirement for subsequent open-heart surgery due to uncontrolled IE. Although the implantation of prosthetic materials in an environment that may have prolonged infection was a concern, the mycotic aneurysms were well treated with embolization and intensive antibiotic therapy, suggesting that endovascular therapy could be an option even in an actively infected mycotic aneurysm.…”

Section: Images In Cardiovascular Medicinementioning

confidence: 99%

Progressive Mycotic Celiac Artery Aneurysm Associated With Coagulase-Negative Staphylococcal Prosthetic Valve Endocarditis

Tanaka

Kohno

Obara

et al. 2018

Circ J

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“…Aneurysms of the celiac artery represent <4% of the aneurysms of visceral vessels, and most are atherosclerotic in etiology. Isolated infective celiac artery aneurysm (ICAA) is an exceedingly rare diagnosis 1, 2, 3, 4, 5, 6, 7…”

mentioning

confidence: 99%

Management of a rapidly expanding celiac artery aneurysm with the chimney technique

Coelho

Monteiro

Nogueira

et al. 2018

Journal of Vascular Surgery Cases, Innovations and Techniques

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Infective celiac artery aneurysm is an extremely rare diagnosis, with few reported cases in the literature. We present the case of a rapidly expanding celiac artery aneurysm involving the ostia, probably infectious, successfully treated in an urgent setting by aneurysm exclusion resorting to the chimney technique. On follow-up, computed tomography angiography revealed complete aneurysm thrombosis and patent celiac artery. Previous reports of endovascular treatment of infective celiac artery aneurysm involved its embolization. This is the first reported case of chimney technique used to exclude a celiac artery aneurysm, with a clinical suspicion of infectious etiology, preserving celiac artery patency. Short-term results are encouraging, but implantation of prosthetic material in an infected environment is a concern.

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Mycotic Celiac Artery Aneurysm Following Infective Endocarditis: Successful Treatment Using N-butyl Cyanoacrylate with Embolization Coils

Cited by 7 publications

References 10 publications

Symptomatic Peripheral Mycotic Aneurysms Due to Infective Endocarditis

Symptomatic Peripheral Mycotic Aneurysms Due to Infective Endocarditis

Progressive Mycotic Celiac Artery Aneurysm Associated With Coagulase-Negative Staphylococcal Prosthetic Valve Endocarditis

Management of a rapidly expanding celiac artery aneurysm with the chimney technique

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