Mycotic Aneurysm Treated with Aneurysm Trapping. Case Report.
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ABSTRACT:
SUBMITTER: Neto S
PROVIDER: S-EPMC4726378 | biostudies-other | 2016 Mar
REPOSITORIES: biostudies-other
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Project description:BackgroundMycotic aneurysm is an uncommon disease which could be fatal without appropriate treatment. Although standard therapy for mycotic aneurysms consists of resection of the infected aorta and in situ graft replacement, some treat with endovascular stent-grafting because patients may not tolerate graft replacement due to underlying diseases. There are 6 more reported cases of mycotic aneurysm caused by Edwardsiella tarda. With the exception of our case, all underwent resection and debridement of the infected aorta or vascular prosthesis. Herein we report the first case ever of mycotic aneurysm caused by E. tarda, successfully treated with stenting and suppressive antibiotic therapy without resection of the infected aorta.Case presentationA 65-year-old Japanese woman with cirrhosis and hepatocellular carcinoma complained of fatigue. Her work up revealed a ruptured aneurysm of the descending aorta. She went through endovascular stent-graft placement. Edwardsiella tarda grew from blood cultures, which led to the diagnosis of mycotic aneurysm. Edwardsiella tarda is a Gram negative bacillus which rarely causes infections in humans. In the case of bacteremia, its mortality is reported to be very high and all reported cases with mycotic aneurysm caused by E. tarda ended up with resection of the infected aorta.ConclusionOur case shows that in the case of mycotic aneurysm caused by E. tarda, endovascular stent-graft placement could be an alternative to in situ graft replacement.
| S-EPMC5944098 | biostudies-literature
Project description:BackgroundInvasive aspergillosis (IA) related mycotic aortic aneurysm is rare in immunocompetent patient. The endovascular therapy remains controversial due to potential risk of graft infection, while the suprarenal cases might face catastrophic complications during open surgery.Case summaryWe presented an IA case with suprarenal abdominal aortic aneurysm confirmed by joint effusion. Multilayer bare stent technique was performed to preserve visceral blood flow and promote aneurysmal thrombus formation, along with antifungal treatment. Two years of follow-up revealed complete aneurysm thrombosis without evidence of infection.DiscussionFungal infection that affects the aorta is difficult to recognize due to often negative blood cultures. Close observation is recommended in case of suspicion of mycotic aneurysms. Multilayer bare stent technique can restore luminal laminar blood flow and reduce the risk of infection in intact mycotic suprarenal aortic aneurysm.
| S-EPMC7793158 | biostudies-literature
Project description:Although mycotic aneurysm is a known and important disease in the cerebrovascular system, especially the brain, there are scarce reports about coronary artery mycotic aneurysms (CAMA). CAMA can occur not only in the context of endocarditis but also as a rare adverse event of coronary artery stenting, which has been used more extensively in recent years. Accordingly, it is essential to pay greater attention to its associated presentations and clinical course. Considering the scant evidence available, reporting the disease course of each patient with CAMA can help increase the physician's knowledge about this condition, which is why we are reporting this case. A 42-year-old man with diabetes was referred to our center with embolic left cerebellar infarction 3 months earlier, as well as a 2-month history of feverishness before his referral. His blood culture was positive for Viridans Streptococci, and he had paraclinical signs of inflammation and two- and three-dimensional transthoracic and transesophageal echocardiography (2D & 3D TTE and TEE) signs of aortic and mitral valves' infective endocarditis with the destruction of the aortic valve, severe aortic and mitral regurgitation, severe pulmonary hypertension, and moderate biventricular systolic dysfunction. Regarding the obviously dilated left main coronary artery on TEE images, contrast-enhanced chest multidetector computed tomography was performed for better assessment of coronary arteries with suspicion of CAMA, which confirmed aneurysmal dilatation of the proximal left main coronary artery. The presence of bacteria was confirmed on staining the valvular tissue, resected during the surgical replacement of aortic and mitral valves. As the cardiac surgeon considered CAMA resection and coronary bypass grafting high risk for the patient, he received parenteral antibiotic therapy, for 6 weeks. At 1-year follow-up, he was doing well with no signs/symptoms of endocarditis and well-functioning mechanical prosthetic valves. This case shows the significance of considering CAMA in the setting of endocarditis, resistant to medical and/or surgical therapy or in patients with coronary aneurysm, simultaneous with active endocarditis. Therefore, more attention should be paid to this extravalvular complication of endocarditis, and its possibility should be considered and investigated in any patient presented with valvular endocarditis, especially involving the aortic valve.
| S-EPMC10435280 | biostudies-literature
Project description:An 86-year-old woman was admitted for a ruptured popliteal artery aneurysm (rPAA, 26 × 28 mm). Due to the patient's age and comorbidities, emergency endovascular repair was performed. After the failed antegrade guidewire crossing, a retrograde approach from the anterior tibial artery and snaring was performed for lesion crossing, and stentgraft (5 × 50 mm) was deployed from antegrade fashion. At the 14-month follow-up, computed tomography angiogram demonstrated stentgraft patency and reduced aneurysmal size. Although open surgery remains the first-line treatment for infected rPAA, our approach adds to the evidence and can be applied to emergency cases or high-risk surgical patients.
| S-EPMC8256240 | biostudies-literature
Project description:An infected mycotic aneurysm due to Streptococcus constellatus subsp. constellatus has not previously been reported. We report on this condition in an 87-year-old woman who had aggravating abdominal pain and a large fusiform aneurysm over the thoracic-abdominal aorta with mural thrombus. Isolates from two sets of blood cultures and the debrided tissue were identified as S. constellatus subsp. constellatus by their biochemical reaction profiles, compatible 16S rRNA gene sequencing results, and sequencing results for the partial groESL gene and the 16S-23S intergenic spacer region.
| S-EPMC387616 | biostudies-literature
Project description:Background: Ruptured intracranial mycotic aneurysms have high morbidity and mortality and present unique surgical challenges because of vessel friability.[1] Flow-preserving strategies are needed for more proximal lesions that cannot be treated with vessel sacrifice. Case Description: A 33-year-old man with no medical history who presented with fevers and peripheral septic emboli was found to have infective cardiac valve vegetations. He reported headaches and left arm weakness; an irregular 7 × 8 × 9 mm bilobed middle cerebral artery mycotic aneurysm involving multiple M3 branches with subarachnoid hemorrhage was found on cranial imaging. Multifocal and small intraparenchymal hemorrhages from septic emboli were also seen. Clip trapping and revascularization were recommended. A right frontotemporal craniectomy was performed, preserving the superficial temporal artery. After extradural exposure, a hole was drilled in the middle fossa floor lateral to the foramen ovale. The Sylvian fissure was split and the larger M3 branch was isolated. An endoscopically harvested saphenous vein graft was anastomosed to the cervical external carotid artery, tunneled through the middle fossa floor, and anastomosed end-to-side to the larger M3. The aneurysm was clip trapped and the involved smaller M3 was transected and anastomosed end-toend to the superficial temporal artery. Indocyanine green videoangiography confirmed patency of both bypasses. Postoperatively, the patient received antibiotics and a mitral valve replacement. He was neurologically intact on 1-month and 2-year follow-up. Conclusion: Although technically demanding, tailored revascularization and clipping of ruptured mycotic cerebral aneurysms are a viable treatment option for these complex lesions.
| S-EPMC9479689 | biostudies-literature
Project description:BackgroundIsolated true aneurysms in the superficial femoral artery (SFA) have rarely been reported. Most cases are undiagnosed until rupture or the occurrence of complications.Case summaryA 36-year-old woman presented with a palpable, pulsating mass on her right thigh which had increased in size over 2 months. She also had a swollen right leg and mild claudication (Stage II in Rutherford classification). For 2 months, the patient was treated by manual massage, acupuncture, and extracorporeal shock wave therapy in local clinics. Bed-side ultrasonography identified a 3.4-cm sized true aneurysm of the right SFA. There were no other aneurysms in arteries from head to toe. There was no evidence of atherosclerotic risk factors or connective tissue disease. The patient was successfully treated by a covered stent graft implantation without any complications.DiscussionIsolated true aneurysm in the SFA is rare and tends to go undiagnosed especially in young women. Ultrasonography is an easy and useful diagnostic tool for differential diagnosis of thigh mass. In this case, endovascular treatment was safely applied for a true aneurysm without rupture.
| S-EPMC7047061 | biostudies-literature
Project description:A 10-year-old castrated male mixed-breed dog exhibited vomiting, lethargy and anorexia. An abdominal ultrasound examination revealed a focal dilation of the abdominal aorta. The dog died 2 days after examination, and necropsy revealed a ruptured aneurysm at the abdominal aorta between the kidneys. Histological examination revealed severe granulomatous and necrotizing pan-arteritis with fungal organisms. Graphium species was identified through DNA sequence analysis of the PCR product from formalin-fixed paraffin-embedded samples. To our knowledge, this is the first report of aortic aneurysm caused by Graphium species in a dog. Sequence was submitted to the DNA Data Bank of Japan with the accession number LC007972.
| S-EPMC4638297 | biostudies-literature
Project description:BackgroundCoronary artery aneurysms (CAAs) of the left main represent a small subset of coronary artery disease and are associated with cardiovascular death. Because of its rare entity, large data are lacking and therefore treatment guidelines are missing.Case summaryWe describe a case of a 56-year-old female with a past medical history of spontaneous dissection of the distal descending left artery (LAD) 6 years before. She presented to our hospital with a non-ST elevation myocardial infarction and a coronary angiogram showed a giant saccular aneurysm of the shaft of the left main coronary artery (LMCA). Given the risk of rupture and distal embolization, the heart team decided to go for a percutaneous approach. Based on a pre-interventional 3D reconstructed CT scan and guided by intravascular ultrasound, the aneurysm was successfully excluded with a 5 mm papyrus-covered stent. At 3-month and 1-year follow-up, the patient is still asymptomatic and repeat angiographies showed full exclusion of the aneurysm and the absence of restenosis in the covered stent.DiscussionWe describe the successful percutaneous IVUS-guided treatment of a giant LMCA shaft coronary aneurysm with a papyrus-covered stent with an excellent 1-year angiographic follow-up showing no residual filling of the aneurysm and no stent restenosis.
| S-EPMC9972523 | biostudies-literature
Project description:Aneurysms of meningeal middle artery (MMA) are extremely rare. These aneurysms are of two types: true aneurysm and pseudoaneurysm. The true type is usually seen with pathologic conditions. Pseudoaneurysms, on the other hand, are associated with a skull fracture. Epilepsy caused by MMA aneurysm has never been described to our knowledge. We report a case of true aneurysm isolated from MMA revealed by epilepsy.A 57-year-old patient with a history of high blood pressure developed epilepsy which was treated by valproic acid. Initial scalp electroencephalography (EEG) showed seizure activity arising from the right temporal area. Epilepsy had become drug-resistant. Cerebral angiography revealed an aneurysm of the right middle meningeal artery without any other intraparenchymal anomaly. The interrogation did not reveal any history of family aneurysm. The patient underwent surgery with coagulation of the aneurysm and the MMA. The aneurysm was intradural in contact with the temporal cortex, and the surrounding brain tissues were preserved. The operative follow-up was favorable with amelioration of convulsions with a single antiepileptic. We planned to stop antiepileptic treatment according to electroencephalograms.Aneurysms of the MMA are rare. Their mode of revelation by seizures is unusual. The factors of rupture are not known. When isolated, their physiopathology is identical to that of the aneurysms of the Willis polygon. Their management uses the same techniques as for other cerebral aneurysms.
| S-EPMC5551285 | biostudies-other