RESUMEN
The aim of this article is to present a case of mycotic aneurysm of internal carotid artery secondary to livestock-associated methicillin-resistant Staphylococcus aureus (LA-MRSA) treated with resection and common-to-internal carotid artery bypass with autologous vein graft in a male pig farmer. A 69-year-old man, pig farmer, with recent dental extraction was admitted with a right cervical pulsatile mass, dysphonia, pain, leukocytosis and elevated C-reactive protein (CRP). Ultrasonography (US) and computed tomography angiography (CTA) showed a 3.9 × 4.5 cm mycotic aneurysm of right internal carotid artery with hypermetabolic uptake in positron emission tomography (PET) scan. Resection of the mycotic aneurysm and a common-to-internal carotid artery bypass with major saphenous vein graft were performed. LA-MRSA clonal complex (CC) 398 was detected in intraoperative samples and antibiotic therapy was changed according to antibiogram. Patient was discharged at the seventh postoperative day and received antibiotic therapy for 6 weeks. US 12 months later showed patency of the bypass without collections. Mycotic aneurysms of internal carotid artery are very infrequent. MRSA isolation is rare, and to the best of our knowledge this is the first case caused by multi-drug resistant LA-MRSA CC398. The treatment includes mycotic aneurysm resection and reconstruction with venous graft bypass plus intensive antibiotic therapy.
Asunto(s)
Aneurisma Infectado/microbiología , Arteria Carótida Interna/microbiología , Staphylococcus aureus Resistente a Meticilina/aislamiento & purificación , Infecciones Estafilocócicas/microbiología , Sus scrofa/microbiología , Anciano , Aneurisma Infectado/diagnóstico , Aneurisma Infectado/cirugía , Animales , Antibacterianos/uso terapéutico , Zoonosis Bacterianas , Arteria Carótida Interna/citología , Arteria Carótida Interna/cirugía , Agricultores , Humanos , Masculino , Vena Safena/trasplante , Infecciones Estafilocócicas/diagnóstico , Infecciones Estafilocócicas/cirugía , Infecciones Estafilocócicas/transmisión , Resultado del TratamientoRESUMEN
OBJECTIVE: In the treatment of an infected aorta, open repair and replacement with a rifampin-impregnated Dacron vascular graft decrease the risk of prosthetic graft infections, with several protocols available in the literature. We hypothesize that the same holds true for endovascular aneurysm repair, and after studying and optimizing rifampin solution concentration and incubation period to maximize the coating process of rifampin on Dacron endovascular stent grafts (ESGs), we propose a rapid real-time perioperative protocol. METHODS: Several prepared rifampin solutions, including a negative control solution, were used to coat multiple triplicate sets of Dacron endovascular aortic stent grafts at different but set incubation periods. Rifampin elution from the grafts was studied by spectroscopic analysis. Once an optimized solution concentration and incubation time were determined, the elution of rifampin over time from the graft and the graft's surface characteristics were studied by ultraviolet-visible spectroscopy and atomic force microscopy. RESULTS: All coated ESGs with any concentration of prepared rifampin solution, regardless of incubation time, immediately demonstrated a visible bright orange discoloration and subsequently after elution procedures returned to the original noncolored state. At the 25-minute incubation time (standard flush), there was no statistical difference in the amount of rifampin coated to the ESGs with 10-mg/mL, 30-mg/mL, and 60-mg/mL solutions (0.06 ± 0.01, 0.07 ± 0.05, and 0.044 ± 0.01, respectively; P > .05). This was also true for a 10-minute incubation time (express flush) of 10-mg/mL and 60-mg/mL rifampin solution concentrations (0.04 ± 0.007 and 0.066 ± 0.014, respectively; P = .22). The elution-over-time of coated rifampin ESG, although not statistically significant, did seem to plateau and to reach a steady state by 50 hours and was confirmed by surface characteristics using atomic force microscopy. CONCLUSIONS: Having studied two variables of rifampin coating techniques to Dacron ESGs, the authors propose a rapid real-time perioperative coating protocol by using a 10-mg/mL rifampin solution for a 10-minute incubation period. As rifampin loosely binds to Dacron ESGs by weak intermolecular forces, a rifampin-coated ESG would need to be inserted in a timely fashion to treat the diseased aorta and to deliver its antibiotic affect. A rapid perioperative coating protocol followed by immediate deployment makes our proposed technique especially useful in an urgent and unstable clinical scenario.
Asunto(s)
Aneurisma Infectado/cirugía , Antibacterianos/química , Aneurisma de la Aorta/cirugía , Implantación de Prótesis Vascular/instrumentación , Prótesis Vascular , Materiales Biocompatibles Revestidos , Procedimientos Endovasculares/instrumentación , Rifampin/química , Stents , Aneurisma Infectado/microbiología , Antibacterianos/administración & dosificación , Aneurisma de la Aorta/microbiología , Liberación de Fármacos , Cinética , Ensayo de Materiales , Microscopía de Fuerza Atómica , Tereftalatos Polietilenos , Diseño de Prótesis , Rifampin/administración & dosificación , Espectrofotometría Ultravioleta , Propiedades de SuperficieRESUMEN
BACKGROUND: The perioperative mortality and morbidity rates of surgical repair of mycotic abdominal aortic aneurysms and aortic graft infections are high, and the appropriate treatment is debated. This retrospective study compared venous and antimicrobial prosthetic aortic graft reconstructions. METHODS: All patients of the Northwest Clinics and St. Antonius Hospital who were treated for mycotic abdominal aortic aneurysms or aortic graft infections between January 1, 2008, and January 1, 2018, were analyzed. Exclusion criterion was treatment other than venous or antimicrobial reconstructions. Primary end points were 30-day complications and mortality rates and 3-year overall survival. Secondary end points were reintervention-free survival, persistent infection and reinfection rates, and hospital length of stay. RESULTS: Fifty-one patients met the inclusion criteria, of whom 32 underwent venous reconstructions and 19 antimicrobial prosthetic aortic graft reconstructions. Baseline characteristics did not differ significantly between these groups, except for duration of surgical repair, which was longer in the venous group. The 30-day and 1-year mortality rates, reinfection rates, complication rates, and hospital length of stay did not significantly differ between the groups. The 3-year overall survival was 77% for venous reconstruction compared with 66% for antimicrobial reconstruction (P = 0.781). The 30-day reintervention rate was 19% for the venous group compared with 42% for the prosthetic group (P = 0.071). Reintervention-free survival at 3 years was 46% for the venous group compared with 52% for the prosthetic group (P = 0.615). CONCLUSIONS: Venous reconstruction tends to have better 3-year overall survival and lower 30-day reintervention rates compared with antimicrobial prosthetic graft reconstruction in patients with mycotic abdominal aortic aneurysms or abdominal aortic graft infections. In the acute setting, antimicrobial prosthetic graft reconstruction is a valuable solution due to the shorter operation time and similar 30-day mortality and complication rates.
Asunto(s)
Aneurisma Infectado/cirugía , Antibacterianos/administración & dosificación , Aneurisma de la Aorta Abdominal/cirugía , Implantación de Prótesis Vascular/efectos adversos , Implantación de Prótesis Vascular/instrumentación , Prótesis Vascular/efectos adversos , Materiales Biocompatibles Revestidos , Vena Femoral/trasplante , Procedimientos de Cirugía Plástica/instrumentación , Infecciones Relacionadas con Prótesis/cirugía , Anciano , Anciano de 80 o más Años , Aneurisma Infectado/diagnóstico , Aneurisma Infectado/microbiología , Aneurisma Infectado/mortalidad , Antibacterianos/efectos adversos , Aneurisma de la Aorta Abdominal/diagnóstico , Aneurisma de la Aorta Abdominal/microbiología , Aneurisma de la Aorta Abdominal/mortalidad , Implantación de Prótesis Vascular/mortalidad , Desbridamiento , Remoción de Dispositivos , Femenino , Humanos , Tiempo de Internación , Masculino , Persona de Mediana Edad , Países Bajos , Supervivencia sin Progresión , Diseño de Prótesis , Infecciones Relacionadas con Prótesis/diagnóstico , Infecciones Relacionadas con Prótesis/microbiología , Infecciones Relacionadas con Prótesis/mortalidad , Procedimientos de Cirugía Plástica/efectos adversos , Procedimientos de Cirugía Plástica/mortalidad , Reoperación , Estudios Retrospectivos , Factores de Riesgo , Factores de TiempoRESUMEN
BACKGROUND: Endovascular repair for mycotic aortic aneurysm (MAA) is a less invasive alternative to open surgery, although the placement of a stent graft in an infected environment remains controversial. In this study, we developed hybrid biodegradable, vancomycin-eluting, nanofiber-loaded endovascular prostheses and evaluated antibiotic release from the endovascular prostheses both in vitro and in vivo. METHODS: Poly(D,L)-lactide-co-glycolide and vancomycin were dissolved in 1,1,1,3,3,3-hexafluoro-2-propanol. This solution was electrospun into nanofibrous tubes, which were mounted onto commercial vascular stents and endovascular aortic stent grafts. In vitro antibiotic release from the nanofibers was characterized using an elution method and high-performance liquid chromatography. Antibiotic release from the hybrid stent graft was analyzed in a three-dimensional-printed model of a circulating MAA. The in vivo drug release characteristics were examined by implanting the antibiotic-eluting stents in the abdominal aorta of New Zealand white rabbits (n = 15). RESULTS: The in vitro study demonstrated that the biodegradable nanofibers and the nanofiber-loaded stent graft provided sustained release of high concentrations of vancomycin for up to 30 days. The in vivo study showed that the nanofiber-loaded stent exhibited excellent biocompatibility and released high concentrations of vancomycin into the local aortic wall for 8 weeks. CONCLUSIONS: The proposed biodegradable vancomycin-eluting nanofibers significantly contribute to the achievement of local and sustainable delivery of antibiotics to the aneurysm sac and the aortic wall, and these nanofibers may have therapeutic applications for MAAs.
Asunto(s)
Implantes Absorbibles , Aneurisma Infectado/cirugía , Antibacterianos/administración & dosificación , Aorta Abdominal/cirugía , Aneurisma de la Aorta/cirugía , Implantación de Prótesis Vascular/instrumentación , Prótesis Vascular , Procedimientos Endovasculares/instrumentación , Ácido Láctico/química , Nanofibras , Ácido Poliglicólico/química , Vancomicina/administración & dosificación , Aneurisma Infectado/diagnóstico por imagen , Aneurisma Infectado/microbiología , Animales , Antibacterianos/farmacocinética , Aorta Abdominal/metabolismo , Aneurisma de la Aorta/diagnóstico por imagen , Aneurisma de la Aorta/microbiología , Aortografía/métodos , Angiografía por Tomografía Computarizada , Preparaciones de Acción Retardada , Implantes de Medicamentos , Liberación de Fármacos , Humanos , Masculino , Modelos Anatómicos , Modelos Animales , Modelos Cardiovasculares , Copolímero de Ácido Poliláctico-Ácido Poliglicólico , Impresión Tridimensional , Diseño de Prótesis , Conejos , Vancomicina/farmacocinéticaRESUMEN
A 65-year-old man presented with an infected perivisceral aortic aneurysm after previous treatment of an abdominal aortic aneurysm with an endograft. On presentation, he was septic and had occlusion of the celiac, superior mesenteric, inferior mesenteric, and bilateral renal arteries. He underwent a three-stage procedure: first, axillobifemoral bypass; then resection of the thoracoabdominal aorta; and finally bypass from the ascending aorta to the celiac and superior mesenteric arteries with a rifampin-soaked Gelsoft graft (Vascutek, Renfrewshire, Scotland). The abdominal pain resolved, and the patient remains symptom free 10 months postoperatively. This rare surgical revascularization technique offered a nontraditional solution to a difficult surgical issue.
Asunto(s)
Aneurisma Infectado/cirugía , Aneurisma de la Aorta Abdominal/cirugía , Implantación de Prótesis Vascular/efectos adversos , Implantación de Prótesis Vascular/instrumentación , Prótesis Vascular/efectos adversos , Remoción de Dispositivos/métodos , Procedimientos Endovasculares/efectos adversos , Procedimientos Endovasculares/instrumentación , Isquemia Mesentérica/cirugía , Oclusión Vascular Mesentérica/cirugía , Infecciones Relacionadas con Prótesis/cirugía , Anciano , Aneurisma Infectado/diagnóstico por imagen , Aneurisma Infectado/microbiología , Aneurisma Infectado/fisiopatología , Antibacterianos/administración & dosificación , Aneurisma de la Aorta Abdominal/diagnóstico por imagen , Aneurisma de la Aorta Abdominal/fisiopatología , Aortografía/métodos , Arteria Celíaca/fisiopatología , Arteria Celíaca/cirugía , Materiales Biocompatibles Revestidos , Circulación Colateral , Angiografía por Tomografía Computarizada , Arteria Hepática/fisiopatología , Arteria Hepática/cirugía , Humanos , Masculino , Arteria Mesentérica Superior/fisiopatología , Arteria Mesentérica Superior/cirugía , Isquemia Mesentérica/diagnóstico por imagen , Isquemia Mesentérica/microbiología , Isquemia Mesentérica/fisiopatología , Oclusión Vascular Mesentérica/diagnóstico por imagen , Oclusión Vascular Mesentérica/microbiología , Oclusión Vascular Mesentérica/fisiopatología , Infecciones Relacionadas con Prótesis/diagnóstico por imagen , Infecciones Relacionadas con Prótesis/microbiología , Infecciones Relacionadas con Prótesis/fisiopatología , Reoperación , Rifampin/administración & dosificación , Circulación Esplácnica , Resultado del TratamientoRESUMEN
BACKGROUND: There is no international consensus regarding the optimum management of infected aortae (mycotic aneurysms, infected aortic grafts). Neoaortoiliac reconstruction has advantages over extra-anatomical bypass grafting; however, the use of autologous vein is associated with venous hypertension and compartment syndrome, alternatively cadaveric homografts are associated with high rates of perianastomotic hemorrhage, limb occlusion, and pseudoaneurysm. Arterial repair using xenoprosthetic patches is associated with lower infection rates compared to the use of prosthetic material. The aim of this case series and literature review is to report the use of xenoprosthetic bovine biomaterial for neoaortic repair of mycotic aneurysmal disease and infected aortic grafts. METHODS: Patients with evidence of infected aortic grafts or mycotic aneurysms who were suitable for open aortic surgery were included. Following removal of the graft/excision of the aneurysmal sac, a 10 × 16 cm XenoSure Biologic Surgical Patch (LeMaitre, Germany) was rolled into a tube, or bifurcated tube graft, and secured with prolene sutures. Proximal and distal anastomoses were conducted as per standard aortic anastomoses. Patients were continued on long-term antibiotics and surveyed with computerized tomography at 1, 3, 6, and 12 months. RESULTS: Six patients underwent bovine aortic repair between 2013 and 2015: an infected Dacron aortobi-iliac graft causing iliac pseudoaneurysm, an infected Dacron aortic graft from open repair later relined with endovascular stent graft, a mycotic iliac aneurysm, and 3 mycotic aortic aneurysms. All were treated with bovine reconstructed aortic grafts or patches. Patients had a median age of 69.5 years (range 67-75), with perioperative and 30-day mortality of 0%. Median follow-up was 13 months (range 2-23). Postoperative contrast-enhanced computed tomography revealed no evidence of infection at the operative site in all patients. Freedom from reinfection and reintervention was 100%. CONCLUSIONS: Xenoprosthetic (bovine) neoaortic grafts are an alternative method to treat infected aortae with excellent short-term freedom from infection and reintervention. Optimum duration of postoperative antibiotic therapy remains undetermined. Further cases and longer follow-up are required to determine the true efficacy of this technique.
Asunto(s)
Aneurisma Infectado/cirugía , Aneurisma de la Aorta/cirugía , Implantación de Prótesis Vascular/instrumentación , Prótesis Vascular , Infecciones Relacionadas con Prótesis/cirugía , Anciano , Aneurisma Infectado/diagnóstico por imagen , Aneurisma Infectado/microbiología , Animales , Antibacterianos/administración & dosificación , Aneurisma de la Aorta/diagnóstico por imagen , Aneurisma de la Aorta/microbiología , Aortografía/métodos , Prótesis Vascular/efectos adversos , Implantación de Prótesis Vascular/efectos adversos , Bovinos , Angiografía por Tomografía Computarizada , Remoción de Dispositivos , Xenoinjertos , Humanos , Tereftalatos Polietilenos , Diseño de Prótesis , Infecciones Relacionadas con Prótesis/diagnóstico por imagen , Infecciones Relacionadas con Prótesis/microbiología , Técnicas de Sutura , Resultado del TratamientoRESUMEN
BACKGROUND: Infected abdominal aortic aneurysms (iAAAs) are rare but life-threatening diseases. The purpose of the present study was to report our experience of extra-anatomic prosthesis bypass in the retroperitoneum as a treatment for iAAAs. METHODS: Data of 8 consecutive patients diagnosed with iAAAs and treated by an extra-anatomic prosthesis bypass in the retroperitoneum were retrospectively collected. Operative details were as follows: one side of the retroperitoneal space was selected to build a track, and a bifurcated expanded polytetrafluoroethylene prosthesis was placed through the track. The proximal end of the prosthesis was sutured with the normal segment of abdominal aorta proximal to the infected aneurysm by end-to-end anostomosis. The 2 distal ends of the prosthesis were, respectively, sutured with the external iliac artery distal to the aneurysm. The anastomoses were then consolidated with the nearby connective tissue. After the closure of the retroperitoneum, the infected aneurysm was incised, and the infected tissue was debrided. Drainage tubes were placed in the aneurysm sac, which was packed with an omentum flap. All patients received perioperative antibiotic therapy for a period of time. All 8 patients were regularly followed up by outpatient observation. RESULTS: Eight patients with iAAAs underwent an extra-anatomic prosthesis bypass in the retroperitoneum and debridement of the infected aneurysm. An emergency operation was performed for 1 patient who underwent concomitant gastrointestinal procedures for aortoduodenal fistula. All 8 patients were definitively diagnosed by one or more sequential computed tomography scans combined with other methods. The blood or tissue cultures of all cases were positive in the perioperative period, with Salmonella (5 cases) being the most common pathogens. Other pathogens included Burkholderia pseudomallei (2 cases) and Escherichia coli (1 case). All patients survived and were discharged in 4-5 weeks after their operations. All patients were free from graft infection during the follow-up period. CONCLUSIONS: The extra-anatomic prosthesis bypass in the retroperitoneum for treating iAAAs was safe and effective. Our experience with the procedure may provide a new approach for the treatment of this disease.
Asunto(s)
Aneurisma Infectado/cirugía , Aneurisma de la Aorta Abdominal/cirugía , Implantación de Prótesis Vascular/métodos , Anciano , Anastomosis Quirúrgica , Aneurisma Infectado/diagnóstico por imagen , Aneurisma Infectado/microbiología , Antibacterianos/administración & dosificación , Aneurisma de la Aorta Abdominal/diagnóstico por imagen , Aneurisma de la Aorta Abdominal/microbiología , Aortografía/métodos , Prótesis Vascular , Implantación de Prótesis Vascular/efectos adversos , Implantación de Prótesis Vascular/instrumentación , China , Angiografía por Tomografía Computarizada , Drenaje , Femenino , Hospitales Generales , Humanos , Masculino , Persona de Mediana Edad , Epiplón/cirugía , Politetrafluoroetileno , Diseño de Prótesis , Espacio Retroperitoneal/cirugía , Estudios Retrospectivos , Colgajos Quirúrgicos , Factores de Tiempo , Resultado del TratamientoRESUMEN
A 63-year-old Caucasian taxi driver presented with a 3-week history of malaise, night sweats, 7 kg weight loss, generalized arthralgia, and persistent mid-lower abdominal pain. Blood inflammatory markers were raised, and a computed tomography scan demonstrated an irregular degeneration of the infrarenal aorta, with a differential diagnosis including aortic infection. An urgent type IV thoracoabdominal aneurysm repair was performed with a rifampicin-soaked aortic tube graft during an open procedure. No organisms were grown from multiple peripheral blood cultures or culture of the affected aorta. However, subsequent 16S ribosomal polymerase chain reaction analysis of the resected aorta identified Capnocytophaga canimorsus as the causative organism-a commensal that lives in the mouth of dogs and cats. The patient subsequently gave a history of multiple bites from his pet dog over recent months-the likely source of infection. He was treated with 8 weeks of intravenous antibiotics before switching to oral antibiotics for an additional 6 weeks.
Asunto(s)
Aneurisma Infectado/microbiología , Aneurisma de la Aorta Torácica/microbiología , Mordeduras y Picaduras/microbiología , Capnocytophaga/aislamiento & purificación , Infecciones por Bacterias Gramnegativas/microbiología , Aneurisma Infectado/diagnóstico por imagen , Aneurisma Infectado/cirugía , Animales , Antibacterianos/uso terapéutico , Aneurisma de la Aorta Torácica/diagnóstico por imagen , Aneurisma de la Aorta Torácica/cirugía , Aortografía/métodos , Mordeduras y Picaduras/complicaciones , Implantación de Prótesis Vascular , Capnocytophaga/clasificación , Capnocytophaga/genética , Angiografía por Tomografía Computarizada , Perros , Infecciones por Bacterias Gramnegativas/diagnóstico , Infecciones por Bacterias Gramnegativas/transmisión , Humanos , Masculino , Persona de Mediana Edad , Tomografía Computarizada por Tomografía de Emisión de Positrones , Ribotipificación , Resultado del TratamientoRESUMEN
BACKGROUND: Mycotic thoracic aortic aneurysms are a life-threatening diagnosis and carry a high risk of morbidity and mortality in the perioperative setting. Traditional open repair consists of debridement, drainage, and either in situ or extra-anatomic bypass. Acute rupture portends a dismal prognosis; however, emergent endovascular repair of ruptured mycotic aneurysms has been described in the literature and we present a case of successful endovascular treatment of a ruptured mycotic descending thoracic aortic aneurysm. CASE REPORT: We report the case of a 42-year-old male with hypertension and active intravenous drug use who presented with 3 weeks of chest pain, dyspnea, and hemoptysis, and on computed tomography scan was found to have a contained 4.1-cm ruptured mycotic thoracic aortic aneurysm. Blood cultures were positive for methicillin-resistant Staphylococcus aureus. Emergent repair was recommended because of likelihood of further rupture and death. Thoracic endovascular aortic repair (TEVAR) was performed using a rifampin-soaked stent graft without complication. At 2-year follow-up, the patient was asymptomatic and imaging demonstrated the stent graft in excellent position, without endoleak, and complete resolution of the aneurysm sac. CONCLUSIONS: TEVAR can be safely employed to treat a ruptured mycotic thoracic aneurysm when open repair is not possible because of patient's comorbidity or complex rupture, as these patients face imminent death. Long-term follow-up is necessary for detection of endoleak, recurrence, or propagation of the aneurysm, and persistent bacterial infections.
Asunto(s)
Aneurisma Infectado/cirugía , Aneurisma de la Aorta Torácica/cirugía , Implantación de Prótesis Vascular , Procedimientos Endovasculares , Staphylococcus aureus Resistente a Meticilina/aislamiento & purificación , Infecciones Estafilocócicas/cirugía , Adulto , Aneurisma Infectado/diagnóstico , Aneurisma Infectado/microbiología , Antibacterianos/administración & dosificación , Aneurisma de la Aorta Torácica/diagnóstico , Aneurisma de la Aorta Torácica/microbiología , Aortografía/métodos , Prótesis Vascular , Implantación de Prótesis Vascular/instrumentación , Materiales Biocompatibles Revestidos , Urgencias Médicas , Procedimientos Endovasculares/instrumentación , Humanos , Masculino , Diseño de Prótesis , Rifampin/administración & dosificación , Infecciones Estafilocócicas/diagnóstico , Infecciones Estafilocócicas/microbiología , Stents , Factores de Tiempo , Tomografía Computarizada por Rayos X , Resultado del TratamientoRESUMEN
We report the case of a 36-year-old male, admitted in the emergency room with a nonruptured brachial pseudoaneurysm after buprenorphine injection, with no signs of distal acute ischemia. After endovascular treatment with a nitinol covered stent associated with adapted antibiotherapy and 35 days of hospitalizations, the patient was discharged with good short results but stent need to be removed at 6 months for thrombosis and partial exposure through the wound.
Asunto(s)
Aneurisma Falso/cirugía , Aneurisma Infectado/cirugía , Arteria Braquial/microbiología , Consumidores de Drogas , Procedimientos Endovasculares , Abuso de Sustancias por Vía Intravenosa/complicaciones , Adulto , Aleaciones , Aneurisma Falso/diagnóstico , Aneurisma Falso/microbiología , Aneurisma Infectado/diagnóstico , Aneurisma Infectado/microbiología , Antibacterianos/uso terapéutico , Arteria Braquial/diagnóstico por imagen , Remoción de Dispositivos , Procedimientos Endovasculares/instrumentación , Humanos , Masculino , Diseño de Prótesis , Stents , Factores de Tiempo , Tomografía Computarizada por Rayos X , Resultado del TratamientoRESUMEN
We describe a case of successful treatment of mycotic pseudoaneurysm of the transverse aortic arch in a male infant. The aneurysm was resected and the defect was repaired using a patch made from a rifampicin-impregnated Dacron graft.
Asunto(s)
Aneurisma Falso/terapia , Aneurisma Infectado/terapia , Antibióticos Antituberculosos/administración & dosificación , Aorta Torácica/cirugía , Tereftalatos Polietilenos , Rifampin/administración & dosificación , Procedimientos Quirúrgicos Vasculares/métodos , Obstrucción de las Vías Aéreas/etiología , Estudios de Seguimiento , Humanos , Lactante , Masculino , Complicaciones Posoperatorias/etiología , Estudios Retrospectivos , Resultado del TratamientoAsunto(s)
Aneurisma Infectado , Aneurisma de la Aorta , Humanos , Tereftalatos Polietilenos , Rifampin , StentsAsunto(s)
Aneurisma Infectado , Aneurisma de la Aorta , Humanos , Tereftalatos Polietilenos , Rifampin , StentsRESUMEN
Treatment of infection-induced aortic aneurysms is among the greatest challenges nowadays of vascular surgery because the use of prosthetic material is considered unsuitable. The Cardiatis multilayer stent (Cardiatis, Isnes, Belgium) is a flow-diverting bare stent with a proven efficacy in peripheral and visceral artery aneurysms. We present a unique case of a Salmonella serotype enteritidis-induced rapidly expanding aortic pseudoaneurysm with a penetrating ulcer that was treated with the Cardiatis multilayer stent. At 18 months of follow-up, the patient was in good clinical condition, with normalized C-reactive protein levels. Computed tomography angiography and 2-deoxy-2-[F18]-fluoro-d-glucose-positron-emission tomography/computed tomography showed a stable, mostly thrombosed aneurysm, with adequate perfusion of the side branches and no remaining signs of infection.
Asunto(s)
Aneurisma Falso/cirugía , Aneurisma Infectado/cirugía , Aneurisma de la Aorta Abdominal/cirugía , Prótesis Vascular , Materiales Biocompatibles Revestidos , Infecciones por Salmonella/cirugía , Stents , Anciano , Aneurisma Falso/diagnóstico , Aneurisma Falso/microbiología , Aneurisma Infectado/diagnóstico , Aneurisma Infectado/microbiología , Aneurisma de la Aorta Abdominal/diagnóstico , Aneurisma de la Aorta Abdominal/microbiología , Estudios de Seguimiento , Humanos , Masculino , Tomografía de Emisión de Positrones , Diseño de Prótesis , Infecciones por Salmonella/diagnóstico , Infecciones por Salmonella/microbiología , Salmonella enteritidis/aislamiento & purificación , Tomografía Computarizada por Rayos X , Vísceras/irrigación sanguíneaAsunto(s)
Aneurisma Falso/terapia , Aneurisma Infectado/terapia , Embolización Terapéutica/métodos , Polivinilos/administración & dosificación , Arteria Pulmonar , Tuberculosis Pulmonar/complicaciones , Adulto , Aneurisma Falso/diagnóstico por imagen , Aneurisma Falso/microbiología , Aneurisma Infectado/diagnóstico por imagen , Aneurisma Infectado/microbiología , Humanos , Masculino , Arteria Pulmonar/diagnóstico por imagen , Resultado del Tratamiento , Tuberculosis Pulmonar/diagnóstico , Tuberculosis Pulmonar/microbiologíaRESUMEN
Campylobacter spp. usually cause gastrointestinal infections, but among them, Campylobacter fetus is a well-known organism causing mycotic abdominal aortic aneurysm (MAAA), which requires proper surgical intervention and antibiotic therapy. We report a 65-year-old man who was successfully treated by an in situ operation using a rifampicin (RFP)-bonded J-Graft for C. fetus-induced MAAA. We performed a review of the English literature on MAAA caused by C. fetus and summarized the results of the cases (28 cases). All but 2 of the patients (92.9%) were men. Blood culture and arterial wall culture were positive in 63% and 73.1% of the cases, respectively. Aneurysm rupture was seen in half of the patients, and approximately half of those patients died. Among the 18 patients who underwent in situ graft replacement, only 1 patient (5.6%) died after surgery. Antibiotic therapy was performed for more than 1 month in most cases, and overall mortality rate was 25.9% (7 of 27 cases, 3 deaths before the operation and 4 deaths after surgery). Although extra-anatomic bypass has been conventionally performed after complete resection of an MAAA, the utility of in situ surgery has generally been recognized. Our review suggests that the in situ operation can be a choice also in cases of C. fetus-associated MAAA. Furthermore, our case suggested the clinical utility of a newly manufactured prosthetic graft, J-Graft, for such surgical treatment.
Asunto(s)
Aneurisma Infectado/microbiología , Aneurisma de la Aorta Abdominal/microbiología , Infecciones por Campylobacter/microbiología , Campylobacter fetus/aislamiento & purificación , Anciano , Aneurisma Infectado/diagnóstico , Aneurisma Infectado/cirugía , Antibacterianos/administración & dosificación , Aneurisma de la Aorta Abdominal/diagnóstico , Aneurisma de la Aorta Abdominal/cirugía , Aortografía/métodos , Biopsia , Prótesis Vascular , Implantación de Prótesis Vascular/instrumentación , Infecciones por Campylobacter/diagnóstico , Infecciones por Campylobacter/cirugía , Materiales Biocompatibles Revestidos , Humanos , Masculino , Diseño de Prótesis , Rifampin/administración & dosificación , Tomografía Computarizada por Rayos X , Resultado del TratamientoRESUMEN
Infections involving the aorta are associated with high rates of morbidity and mortality, and their management is complex. Saturating Dacron grafts in rifampin (60 mg/mL) inhibits the growth of organisms commonly found to be involved in both primary aortic infections and aortoenteric fistulas. Open repair and replacement of the aorta with rifampin-soaked Dacron grafts is frequently used in clinical practice and is considered a viable option for open repair with a low recurrence of infection; however, the morbidity and mortality of the procedure is significant. More recently, patients who are high risk for open surgery have been managed with endografts to treat infected aortas and aortoenteric fistulas with limited success, a high recurrence rate, and elevated mortality. We describe a technique to expose Dacron endografts with rifampin delivered via injection port or into the sheath before deployment in selected patients with aortic infections. We used this novel technique in 2 patients who were high risk for open repair: 1 with a bleeding aortoenteric fistula and 1 with mycotic abdominal aortic aneurysm. The first patient tolerated 1.5 years without surgical correction of the duodenal defect after placement of a rifampin-treated endograft. This allowed her to recover and ultimately undergo definitive repair under elective circumstances. Our second patient remains without evidence of recurrence 1 year after implantation for a mycotic abdominal aortic aneurysm. Following the principles of rifampin use in open vascular repairs, treating Dacron endografts with rifampin may add similar antimicrobial resistance when used to treat selected aortic infections.
Asunto(s)
Aneurisma Infectado/cirugía , Antibacterianos/administración & dosificación , Aneurisma de la Aorta Abdominal/cirugía , Implantación de Prótesis Vascular/instrumentación , Prótesis Vascular , Procedimientos Endovasculares/instrumentación , Tereftalatos Polietilenos , Rifampin/administración & dosificación , Adulto , Anciano , Aneurisma Infectado/diagnóstico , Aneurisma Infectado/microbiología , Aneurisma de la Aorta Abdominal/diagnóstico , Aneurisma de la Aorta Abdominal/microbiología , Aortografía/métodos , Femenino , Humanos , Diseño de Prótesis , Tomografía Computarizada por Rayos X , Resultado del TratamientoRESUMEN
Infectious aortitis is a rare disease with an unfavorable prognosis, although prompt and adequate treatment can reduce its high mortality rate. Pseudoaneurysms caused by aortitis tend to rupture when treatment is delayed. For this reason, determining the appropriate timing of surgical repair is critical. To date, there are no data regarding the expansion rate of the aortic wall after an aortic infection. We report a case of successful surgical treatment of rapidly progressing aortic expansion that resulted from severe infectious aortitis using in situ reconstruction. No complications were experienced by this patient over the 4-year follow-up period.
Asunto(s)
Aneurisma Falso/cirugía , Aneurisma Infectado/cirugía , Aneurisma de la Aorta/cirugía , Rotura de la Aorta/cirugía , Aortitis/cirugía , Implantación de Prótesis Vascular/instrumentación , Prótesis Vascular , Politetrafluoroetileno , Infecciones por Salmonella/cirugía , Anciano , Aneurisma Falso/diagnóstico , Aneurisma Falso/microbiología , Aneurisma Infectado/diagnóstico , Aneurisma Infectado/microbiología , Aneurisma de la Aorta/diagnóstico , Aneurisma de la Aorta/microbiología , Rotura de la Aorta/diagnóstico , Rotura de la Aorta/microbiología , Aortitis/diagnóstico , Aortitis/microbiología , Aortografía/métodos , Progresión de la Enfermedad , Humanos , Masculino , Diseño de Prótesis , Infecciones por Salmonella/complicaciones , Infecciones por Salmonella/diagnóstico , Infecciones por Salmonella/microbiología , Índice de Severidad de la Enfermedad , Factores de Tiempo , Tomografía Computarizada por Rayos X , Resultado del TratamientoRESUMEN
PURPOSE: Neutrophils have been shown to be involved in all stages of human and experimental abdominal aortic aneurysm (AAA) development. The initial processes of neutrophil rolling and trapping in the intraluminal thrombus (ILT) are mediated mainly by P-selectin expressed by activated platelets. In the present study, we propose to evaluate the beneficial effect of fucoidan, a competitive binding agent of P-selectin, on aneurysmal growth in a rat model of aortic aneurysm with neutrophil enrichment of the ILT induced by repeated episodes of weak bacteremia. METHODS: Sixty Lewis rats with experimental AAAs, developed from decellularized aortic xenografts, were divided into four groups. Two groups were used as controls: group fucoidan control (FC) was treated with 200 mg of fucoidan (F) delivered by 2 mL, 4-week osmotic pumps placed intraperitoneally before closing the abdomen, and group C received saline instead of fucoidan. Two more groups were injected weekly with Porphyromonas gingivalis (P. gingivalis [Pg]): group F+Pg received 200 mg of intraperitoneal fucoidan and group Pg received saline. AAAs were harvested after 4 weeks and peripheral blood was sampled at that time. Cell-free DNA (cf-DNA) and myeloperoxydase (MPO) antigen concentrations were determined in plasma and in AAA-conditioned media. Histology and P-selectin immunostaining were performed on AAA tissue samples. RESULTS: Comparing rats injected with Pg, those receiving fucoidan presented reduced aneurysmal diameter. Histologic analysis of AAAs showed that fucoidan reduced the ILT thickness in Pg-injected rats, with fewer trapped neutrophils, and with signs of a healing process, as observed in control group C. Immunohistological analysis revealed a substantial decrease in P-selectin immunostaining at the luminal surface of aneurysms in fucoidan-treated rats compared to the other groups, suggesting an interaction between fucoidan and P-selectin. A significant decrease in MPO concentrations in both plasma and conditioned medium was induced by fucoidan treatment in Pg-injected rats, reflecting a pacification of the ILT biological activity. This effect was associated with a reduction in neutrophil activation and apoptosis, reflected by a significant decrease in cf-DNA concentration in both plasma and conditioned medium of fucoidan-treated rats. CONCLUSIONS: Our results suggest that fucoidan has a beneficial effect on experimental aneurysmal degeneration by decreasing neutrophil activation in the ILT enhanced by weak pathogen contamination. This effect seems to be related to its interaction with P-selectin, which may decrease the trapping of neutrophils into the ILT. Fucoidan could represent a therapeutic option in AAAs to decrease the neutrophil activation involved in the degenerative process of aneurysmal expansion and rupture.