Thoracoabdominal aortic aneurysm associated with umbilical artery catheterization: Case report and review of the literature

The use of synthetic material for reconstructive vascular surgery was first reported during the early 1950s. Infection involving vascular graft prostheses is an infrequent but devastating complication of reconstructive vascular graft surgery and is associated with a high morbidity and, in some situations, mortality. Improvements in surgical techniques and graft design, including the use of native venous or arterial tissue, have reduced the frequency of infection and severity of complications from vascular graft infection (VGI). However, these advances have also led to more frequent vascular graft procedures occurring in a patient population with multiple underlying comorbidities that would have previously disqualified them as candidates for vascular reconstructive surgery. Underlying comorbidities, such as diabetes mellitus or immune compromise, increase the risk of infection and serious infection-related complications. The major complications of VGI include sepsis, amputation, disruption of infected anastomotic suture line with rupture or pseudoaneurysm formation, embolization of infected thrombi, reinfection of reconstructed vascular grafts, enteric fistulae to the small or large bowel, bacteremic spread of infection to other sites, and death. VGIs can be categorized broadly into those that occur in an extracavitary location, primarily in the groin or lower extremities, or in an intracavitary location, primarily within the abdomen or less commonly within the thorax. frequencyThe frequency of VGI depends on the anatomic location of the graft. The infection rate is 1.5% to 2% for most extracavitary grafts and as high as 6% with vascular grafts in the groin. [1][2][3][4][5][6][7][8][9] For intracavitary grafts, the infection rate is ≈1% to 5%. 1-6 Graft infection is most common after emergency procedures and after reoperation. [1][2][3][4]10 Aortic graft erosion or fistulous communication into the duodenum or other areas of the bowel reportedly occurs in 1% to 2% of patients after aortic reconstruction. 11,12 MicrobiologyThe microbiological cause of VGI has evolved over the years. 1 In early published studies, Staphylococcus aureus was the predominant microorganism recovered. 1,13 Improvements in surgical technique, administration of prophylactic antistaphylococcal antimicrobial therapy, and other factors have resulted in a changing microbiological epidemiology. Vascular graft surgery performed on patients with multiple underlying comorbidities and the increased frequency of emergency procedures have contributed to the changing spectrum of infection. Other factors such as changes in hospital flora, surgery in patients with complicated vascular anatomy, and multiple revisions of previous vascular surgery have resulted in a more diverse microbio- clInIcal stateMents anD GuIDelInes logical spectrum of infection, which includes multidrugresistant strains, polymicrobial infection, and Candida species. Gram-positive cocci accounts for at least two thirds of VGIs. 1,13 Infections caused by coagulase-negative staphylococ...

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“…119 MAs are rare in children, 120 and a form associated with umbilical artery catheterization in newborns occurs rarely. 121 …”

Section: Frequencymentioning

confidence: 99%

Vascular Graft Infections, Mycotic Aneurysms, and Endovascular Infections: A Scientific Statement From the American Heart Association

Wilson¹,

Bower²,

Creager³

et al. 2016

Circulation

373

307

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“…With the exception of coronary and intracranial aneurysms, fewer than 200 paediatric cases have been reported (Darden et al, 1984;Sarkar et al, 1991;Cribari et al, 1992;Esper et al, 1993). We present a case in which an abdominal aortic aneurysm was diagnosed prenatally.…”

Section: Introductionmentioning

confidence: 82%

Prenatal Ultrasound Diagnosis of Abdominal Aortic Aneurysm With Fibrotic Occlusion in Aortic Branch Vessels

et al. 1997

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In a 35‐year‐old multiparous patient, an ultrasound scan performed at 32 weeks' gestational age for size less than dates revealed an appropriately grown fetus with a two‐vessel umbilical cord. Also noted were dilated, tortuous abdominal and pelvic vessels. A scan at 33·5 weeks confirmed the two‐vessel cord and noted a widely dilated abdominal aorta and a left foot 2 cm shorter than the right. Delivery at 36 weeks was followed by a neonatal course complicated by thromboses, renovascular hypertension, and a newly patent ductus with pulmonary hypertension. Successful ligation was followed by acute pulmonary hypertension, cardiac dysfunction and death. Autopsy findings included aneurysmal dilation of the abdominal aorta without evidence of arterial wall pathology. © 1997 John Wiley & Sons, Ltd.

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“…To date, only 35 cases have been reported in the world literature. 1,5 Two were congenital and were diagnosed in utero by ultrasound. 6,13 Congenital aneurysms have been associated with the connective tissue disorders of Ehlers-Danlos and Marfan syndromes.…”

Section: Discussionmentioning

confidence: 99%

“…The septic episode and the development of an aneurysm may be separated in time from as little as a few days to as long as five years. 5,13 Other presenting signs include embolic phenomena, hypertension, renal failure, unexplained anemia and thrombocytopenia. 12,13 The diagnosis can usually be confirmed with ultrasound or CT. Aneurysms of the abdominal aorta in children carry a very high mortality rate.…”

Section: Discussionmentioning

confidence: 99%

Abdominal Aortic Aneurysm in Infant

Khougeer

Algarni

1999

Ann Saudi Med

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Abdominal aortic aneurysm (AAA) is rare in infants and children, with only 35 cases previously reported in the world literature. A few may be congenital in origin but most of them are mycotic, arising from septic complications following umbilical artery catheterization. With prompt diagnosis and surgical repair, excellent results can be achieved. Case ReportA male child aged seven months presented with a pulsatile mass in the lower abdomen. He was premature at birth and required treatment for respiratory distress syndrome that included umbilical artery catheterization. He otherwise appeared normal, and apart from the abdomen, physical examination was unremarkable. The abdominal mass measured approximately 6 cm in diameter and extended from the mid-abdomen into the pelvis. Abdominal ultrasound demonstrated infrarenal abdominal aortic aneurysm measuring 3.5 cm anteroposterially and 6.5 cm in length.Angiogram confirmed the presence of a large saccular aneurysm of the distal aorta extending down into the pelvis and partially filled with clot. Severe stenosis of proximal iliac vessels and distal aortic aneurysm, but apparently normal external iliac and femoral arteries, were demonstrated on CT angiogram (Figure 1). Other investigations including cardiac echo and blood cultures, CBC, ESR, renal and hepatic profiles were normal.The abdomen was opened through a transverse incision. The saccular aneurysm was resected and the aorta was patched with polytetrafluorethylene (PTFE). The left common iliac artery was very small and underdeveloped, while the right common iliac appeared to be normal. The patient's postoperative recovery was uneventful, and he was discharged home. A postoperative CT angiogram demonstrated excellent blood flow through the iliac vessels, and the appearance of the aorta revealed no residual aneurysm (Figure 2). Long-term follow-up of about three years showed good blood flow to both legs and no recurrence of the aneurysm.

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Thoracoabdominal aortic aneurysm associated with umbilical artery catheterization: Case report and review of the literature

Cited by 35 publications

References 37 publications

Vascular Graft Infections, Mycotic Aneurysms, and Endovascular Infections: A Scientific Statement From the American Heart Association

Vascular Graft Infections, Mycotic Aneurysms, and Endovascular Infections: A Scientific Statement From the American Heart Association

Prenatal Ultrasound Diagnosis of Abdominal Aortic Aneurysm With Fibrotic Occlusion in Aortic Branch Vessels

Abdominal Aortic Aneurysm in Infant

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