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1.
BMC Surg ; 21(1): 138, 2021 Mar 17.
Artigo em Inglês | MEDLINE | ID: mdl-33731071

RESUMO

BACKGROUND: So called "mycotic" aortic aneurysms account for only 0.7 to 1.3% of all aortic aneurysms and are commonly caused by Staphylococcus aureus and Salmonella species. Bacillus Calmette-Guérin (BCG), a live attenuated strain of Mycobacterium bovis, is part of the therapy of non-muscle-invasive bladder cancer (NMIBC). CASE PRESENTATION: We report a case series of three patients with a mycobacterial graft infection related to BCG after surgical treatment of a presumed mycotic aortic aneurysm as an extremely rare complication after NMIBC treatment. All three patients developed aortic aneurysm after BCG instillation and subsequent mycobacterial graft infection. CONCLUSION: Diagnosis requires a high degree of suspicion because of its nonspecific symptoms and imaging. The pathogen is not detected by standard microbiological testing. Treatment includes triple antimycobacterial therapy and radical surgical interventions. Graft preservation may be considered if no anastomosis is involved.


Assuntos
Aneurisma Infectado/microbiologia , Aneurisma Aórtico/terapia , Vacina BCG/efeitos adversos , Imunoterapia/efeitos adversos , Infecções por Mycobacterium/complicações , Mycobacterium bovis/isolamento & purificação , Neoplasias da Bexiga Urinária/tratamento farmacológico , Administração Intravesical , Idoso , Antibacterianos/uso terapêutico , Vacina BCG/administração & dosagem , Humanos , Masculino , Pessoa de Meia-Idade , Infecções por Mycobacterium/tratamento farmacológico , Tomografia Computadorizada por Raios X , Resultado do Tratamento
3.
Medicine (Baltimore) ; 100(7): e24796, 2021 Feb 19.
Artigo em Inglês | MEDLINE | ID: mdl-33607839

RESUMO

RATIONAL: Bacillus Calmette-Guérin (BCG) intravesical instillation therapy is a widely used treatment for bladder cancer; however, an infectious aneurysm has been reported as a rare complication. PATIENT CONCERNS: A 76-year-old man who underwent BCG intravesical instillation therapy for bladder cancer presented with prolonged dull back pain for 3 months. DIAGNOSIS: Computed tomography (CT) revealed both thoracic and abdominal aortic aneurysms (AAAs). Follow-up CT at 4 weeks after the initial examination showed rapid enlargement of both aneurysms and typical findings of inflammation. Therefore, he was diagnosed with an impending rupture of infectious aneurysms. INTERVENTIONS: Although open surgical resection of both aneurysms and vascular reconstruction were ideal, these operations were considered highly invasive for the patient. Therefore, a hybrid operation consisting of simultaneous endovascular repair of the thoracic aneurysm and open surgery of the abdominal lesion was performed. OUTCOMES: BCG "Tokyo-172" strain was identified in the resected sample from the aneurysmal wall, and he continued to receive oral antituberculosis drugs for 6 months. No sign of recurrent infection was observed 1 year after the operation. LESSONS: A hybrid operation might be justified as an alternative to the conventional open surgical procedure, especially for patients with infectious aneurysms caused by weak pathogenic bacteria such as, the BCG mycobacteria.


Assuntos
Aneurisma Infectado/etiologia , Aneurisma da Aorta Abdominal/cirurgia , Aneurisma da Aorta Torácica/cirurgia , Vacina BCG/efeitos adversos , Neoplasias da Bexiga Urinária/tratamento farmacológico , Administração Intravesical , Idoso , Aneurisma Infectado/microbiologia , Aneurisma da Aorta Abdominal/diagnóstico por imagem , Aneurisma da Aorta Abdominal/microbiologia , Aneurisma da Aorta Torácica/diagnóstico por imagem , Aneurisma da Aorta Torácica/microbiologia , Vacina BCG/administração & dosagem , Humanos , Masculino , Mycobacterium/isolamento & purificação , Tomografia Computadorizada por Raios X
5.
PLoS Negl Trop Dis ; 14(8): e0008525, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32785225

RESUMO

Burkholderia pseudomallei is the causative agent of melioidosis, endemic in Southeast Asia and Northern Australia, and increasingly recognized in southern China, especially in Hainan Province. Mycotic aneurysm caused by B. pseudomallei is a rare but potentially severe illness with a high mortality rate. The clinical features of the mycotic aneurysm secondary to melioidosis have not been illustrated in China. Over a seven-year period (2013 to 2019), 159 patients with bacteremic melioidosis were retrospectively analyzed in Hainan province, China, of whom eight patients were confirmed to have mycotic aneurysm through the combination of imaging examination, pathologic examination and aneurysm tissue culture. We summarized these eight patients' clinical characteristics, demographical features, treatments and outcomes. The susceptibilities to five commonly-used antibiotics for these eight B. pseudomallei isolates were also determined by E-test strips. Furthermore, the mycotic aneurysm cases secondary to melioidosis retrieved from the literature were also reviewed. Of the eight cases, six had abdominal mycotic aneurysms, one had a left iliac aneurysm, and the other one had an infectious mesenteric aneurysm. They were aged from 48 to 69 years old, and had the underlying risk factors of diabetes mellitus (2 patients), long-term smoking (4 patients), hypertension (6 patients), and soil and water contact history (6 patients), respectively. The positive arterial aneurysm imaging was observed in all patients via computed tomography (CT) or angiography. Eight B. pseudomallei isolates collected from both blood and mycotic aneurysm tissues remained 100% susceptible to imipenem and ceftazidime. After surgery combined with antibiotic administration, six patients survived, with a mortality rate of 25%. In melioidosis endemic areas, the mycotic aneurysm secondary to melioidosis might be underdiagnosed, and increased awareness of predisposing risk factors and clinical features of the mycotic aneurysm is required. Following a positive B. pseudomallei blood culture, the diagnosis of mycotic aneurysm should be under consideration in those with abdominal pain and/or hypertension. Imaging by CT or angiography is indispensable for its timely diagnosis and management.


Assuntos
Aneurisma Infectado/complicações , Aneurisma Infectado/diagnóstico por imagem , Burkholderia pseudomallei/isolamento & purificação , Melioidose/complicações , Melioidose/diagnóstico por imagem , Idoso , Aneurisma Infectado/tratamento farmacológico , Aneurisma Infectado/microbiologia , Burkholderia pseudomallei/efeitos dos fármacos , Burkholderia pseudomallei/genética , Ceftazidima , China , Feminino , Humanos , Imipenem , Masculino , Melioidose/tratamento farmacológico , Melioidose/microbiologia , Testes de Sensibilidade Microbiana , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Risco , Solo , Tomografia Computadorizada por Raios X , Sequenciamento Completo do Genoma
6.
Ann Vasc Surg ; 69: 454.e1-454.e5, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-32768535

RESUMO

PURPOSE: The aim of this study is to show the utility of the combination of thrombin and endograft to solve an urgent situation related to femoral infections. CASE: We present the case of a 91-year-old female patient who underwent a femoral endarterectomy and superficial femoral artery angioplasty and developed a surgical site infection. She was readmitted to the hospital because of bleeding and was operated to suture the femoral patch and to do a plasty of sartorius muscle. Six days after the last intervention a femoral pulsatile mass was noted, and the computed tomography showed a big femoral pseudoaneurysm. Taken again to the theater and via a contralateral puncture a viabahn covered endograft was deployed from the external iliac artery to the yet diseased but patent femoral superficial femoral artery and the pseudoaneurysm was punctured, emptied, and filled with thrombin. The patient was discharged 2 weeks after the last procedure and lived for 10 months (she died because of a nonvascular related cause) with a patent graft and with healed lesions. CONCLUSIONS: In this case the endovascular solution was a definitive solution in a very old patient with several comorbidities.


Assuntos
Falso Aneurisma/terapia , Aneurisma Infectado/terapia , Implante de Prótese Vascular , Embolização Terapêutica , Procedimentos Endovasculares , Artéria Femoral , Idoso de 80 Anos ou mais , Falso Aneurisma/diagnóstico por imagem , Falso Aneurisma/microbiologia , Aneurisma Infectado/diagnóstico por imagem , Aneurisma Infectado/microbiologia , Prótese Vascular , Implante de Prótese Vascular/instrumentação , Procedimentos Endovasculares/instrumentação , Feminino , Artéria Femoral/diagnóstico por imagem , Artéria Femoral/microbiologia , Humanos , Resultado do Tratamento
8.
Asian Cardiovasc Thorac Ann ; 28(5): 279-281, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32483974

RESUMO

Mycobacterium tuberculosis is a very rare cause of extracranial carotid artery pseudoaneurysm. A 39-year-old man presented with a rapidly increasing neck mass and hoarseness of voice for 15 days. He was on antitubercular treatment for pulmonary tuberculosis. Computed tomography angiography showed a large pseudoaneurysm of the right common carotid artery. Emergency surgery was performed to excise the pseudoaneurysm sac and repair the artery with a Dacron graft. Postoperative angiography showed normal flow in the carotids and cerebral circulation. Histology of the excised tissue was consistent with a tubercular etiology of the pseudoaneurysm.


Assuntos
Falso Aneurisma/microbiologia , Aneurisma Infectado/microbiologia , Doenças das Artérias Carótidas/microbiologia , Mycobacterium tuberculosis/isolamento & purificação , Tuberculose Pulmonar/microbiologia , Adulto , Falso Aneurisma/diagnóstico por imagem , Falso Aneurisma/cirurgia , Aneurisma Infectado/diagnóstico por imagem , Aneurisma Infectado/cirurgia , Antituberculosos/uso terapêutico , Implante de Prótese Vascular , Doenças das Artérias Carótidas/diagnóstico por imagem , Doenças das Artérias Carótidas/cirurgia , Humanos , Masculino , Resultado do Tratamento , Tuberculose Pulmonar/diagnóstico , Tuberculose Pulmonar/tratamento farmacológico
9.
J Med Vasc ; 45(4): 177-183, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32571557

RESUMO

OBJECTIVE: To evaluate the short and long-term results of in situ prosthetic graft treatment using rifampicin-soaked silver polyester graft in patients with aortic infection. MATERIAL AND METHOD: All the patients surgically managed in our center for an aortic infection were retrospectively analyzed. The primary endpoint was the intra-hospital mortality, secondary outcomes were limb salvage, persistent or recurrent infection, prosthetic graft patency, and long-term survival. RESULTS: From January 2004 to December 2015, 18 consecutive patients (12 men and 6 women) were operated on for aortic infection. Six mycotic aneurysms and 12 prosthetic infections, including 8 para-entero-prosthetic fistulas, were treated. In 5 cases, surgery was performed in emergency. During the early postoperative period, we performed one major amputation and two aortic infections were persistent. Intra-hospital mortality was 27.7%. The median follow-up among the 13 surviving patients was 26 months. During follow-up, none of the 13 patients presented reinfection or bypass thrombosis. CONCLUSION: This series shows that in situ revascularization with rifampicin-soaked silver polyester graft for aortic infection have results in agreement with the literature in terms of intra-hospital mortality with a low reinfection rate.


Assuntos
Aneurisma Infectado/cirurgia , Antibacterianos/administração & dosagem , Aneurisma Aórtico/cirurgia , Implante de Prótese Vascular/instrumentação , Prótese Vascular , Poliésteres , Infecções Relacionadas à Prótese/cirurgia , Rifampina/administração & dosagem , Prata , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Aneurisma Infectado/diagnóstico por imagem , Aneurisma Infectado/microbiologia , Aneurisma Infectado/mortalidade , Antibacterianos/efeitos adversos , Aneurisma Aórtico/diagnóstico por imagem , Aneurisma Aórtico/microbiologia , Aneurisma Aórtico/mortalidade , Prótese Vascular/efeitos adversos , Implante de Prótese Vascular/efeitos adversos , Implante de Prótese Vascular/mortalidade , Feminino , França , Mortalidade Hospitalar , Humanos , Masculino , Pessoa de Meia-Idade , Poliésteres/efeitos adversos , Desenho de Prótese , Infecções Relacionadas à Prótese/diagnóstico por imagem , Infecções Relacionadas à Prótese/microbiologia , Infecções Relacionadas à Prótese/mortalidade , Estudos Retrospectivos , Rifampina/efeitos adversos , Fatores de Risco , Prata/efeitos adversos , Fatores de Tempo , Resultado do Tratamento , Adulto Jovem
10.
Ann Vasc Surg ; 68: 536-541, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32502673

RESUMO

BACKGROUND: The absence of recommendations for the systematic collection of microbiological specimens to help determine the management of infective native aortic aneurysms (INAAs) may lead to diagnostic difficulty and suboptimal antibiotic treatment. In this review, we attempt to establish recommendations in the field by identifying current strategies for the diagnosis and management of INAA and comparing them with those for infective endocarditis (IE). METHODS: A systematic literature review of Medline and ScienceDirect databases was performed using PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analyses)methodology to identify guidelines for the management of INAA. These guidelines were scrutinized for recommendations concerning the procurement of microbiological specimens according to a defined protocol and involvement of specialists in infectious diseases and compared with current practice for IE. RESULTS: Three guidelines were found to have sections dedicated to INAA. Of these, none provided any recommendations concerning the procurement of microbiological specimens for diagnostic and therapeutic purposes. The guidelines from the American Heart Association recommend that patients with INAA should be managed by a team of specialists (including representation from the fields of infectious diseases and/or microbiology). Current guidelines for the investigation and management of IE provide detailed recommendations concerning the procurement of microbiological specimens for diagnostic and therapeutic purposes, as well as the involvement of specialists in infectious medicine in multidisciplinary management. CONCLUSION: This article emphasizes the absence of recommendations for the optimal diagnosis and management of patients with INAAs. While specific research is required to create evidence-based recommendations, application of strategies to identify microorganisms and multidisciplinary team management derived from the management of IE may be both safe and appropriate for the clinical management of this highly complex and heterogeneous group.


Assuntos
Aneurisma Infectado/terapia , Aneurisma Aórtico/terapia , Técnicas Bacteriológicas , Endocardite/terapia , Padrões de Prática Médica , Manejo de Espécimes , Aneurisma Infectado/diagnóstico , Aneurisma Infectado/microbiologia , Aneurisma Aórtico/diagnóstico , Aneurisma Aórtico/microbiologia , Técnicas Bacteriológicas/normas , Tomada de Decisão Clínica , Consenso , Endocardite/diagnóstico , Endocardite/microbiologia , Humanos , Guias de Prática Clínica como Assunto , Padrões de Prática Médica/normas , Valor Preditivo dos Testes , Prognóstico , Manejo de Espécimes/normas
11.
Cardiovasc Pathol ; 48: 107223, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32470823

RESUMO

Saprochaete species infection is a rare fungal disease reported so far only in immunocompromised patients. We describe the first case of aortitis caused by Saprochaete capitata, presenting as ascending aorta aneurysm, with secondary endophthalmitis in an immunocompetent patient. Infection by Saprochaete capitata is potentially fatal, with a mortality ranging from 50% to 90% of cases. In the present case aortic aneurysm caused by Saprochaete capitata aortitis was successfully treated by the combination of accurate diagnosis with surgical and specific antifungal therapy.


Assuntos
Aneurisma Infectado/microbiologia , Aneurisma Aórtico/microbiologia , Aortite/microbiologia , Imunocompetência , Infecções Fúngicas Invasivas/microbiologia , Revascularização Miocárdica/efeitos adversos , Saccharomycetales/isolamento & purificação , Idoso , Aneurisma Infectado/diagnóstico , Aneurisma Infectado/imunologia , Aneurisma Infectado/terapia , Antibacterianos/uso terapêutico , Aneurisma Aórtico/diagnóstico , Aneurisma Aórtico/imunologia , Aneurisma Aórtico/terapia , Aortite/diagnóstico , Aortite/imunologia , Aortite/terapia , Implante de Prótese Vascular , Humanos , Infecções Fúngicas Invasivas/diagnóstico , Infecções Fúngicas Invasivas/imunologia , Infecções Fúngicas Invasivas/terapia , Masculino , Saccharomycetales/efeitos dos fármacos , Saccharomycetales/imunologia , Resultado do Tratamento
12.
Ann Vasc Surg ; 67: 185-191, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32335251

RESUMO

BACKGROUND: Infected false aneurysms (IFA) caused by intravenous drug abuse are uncommon but challenging lesions. The best approach for the surgical management of this condition is still unknown. The aim is to present a single-center 14-year experience in the IFA treatment in intravenous drug abusers, thus providing additional data regarding the treatment options and outcome in these patients. METHODS: A retrospective analysis of 32 consecutive patients with vascular injuries secondary to intravenous drug abuse, during the period from January 2004 to April 2018, was performed. Data of interest were extracted from patients' medical history records, anesthesia charts, and database implemented in daily practice, or were obtained by personal contact. The diagnosis was set based on history, physical examination and/or color Doppler sonography, multidetector computed tomographic angiography, and digital subtraction angiography. The outcome included graft patency, limb amputation, and mortality. RESULTS: During study period, 32 heroin abusers, predominantly males (81%), were surgically treated due to vascular injuries, with mean age of 35.2 years. The vast majority of patients have had an injury of the lower extremity blood vessels (84.3%) and the common femoral artery was the most common site of injury (59.4%). Three-quarters of patients underwent resection of the false aneurysm and ligation of the artery without reconstruction of the blood vessel. In 7 cases (21.9%), arterial reconstruction was performed with overall failure rate of 42.86%. The overall mortality rate was 6.25% and the rate of extremity salvage was 96.7%. CONCLUSIONS: The best treatment option is yet to be found, but based on the results of the present study, ligation of affected artery without revascularization seems to be an efficient, safe, and optimal treatment method, with minor risk of the extremity loss.


Assuntos
Falso Aneurisma/cirurgia , Aneurisma Infectado/cirurgia , Implante de Prótese Vascular , Usuários de Drogas , Dependência de Heroína/complicações , Abuso de Substâncias por Via Intravenosa/complicações , Lesões do Sistema Vascular/cirurgia , Adulto , Amputação , Falso Aneurisma/diagnóstico por imagem , Falso Aneurisma/microbiologia , Falso Aneurisma/mortalidade , Aneurisma Infectado/diagnóstico por imagem , Aneurisma Infectado/microbiologia , Aneurisma Infectado/mortalidade , Prótese Vascular , Implante de Prótese Vascular/efeitos adversos , Implante de Prótese Vascular/instrumentação , Implante de Prótese Vascular/mortalidade , Feminino , Dependência de Heroína/diagnóstico , Dependência de Heroína/mortalidade , Humanos , Ligadura , Salvamento de Membro , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Risco , Abuso de Substâncias por Via Intravenosa/diagnóstico , Abuso de Substâncias por Via Intravenosa/mortalidade , Fatores de Tempo , Resultado do Tratamento , Grau de Desobstrução Vascular , Lesões do Sistema Vascular/diagnóstico por imagem , Lesões do Sistema Vascular/microbiologia , Lesões do Sistema Vascular/mortalidade
13.
Ann Vasc Surg ; 68: 569.e13-569.e20, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32339680

RESUMO

Melioidosis abdominal aortic aneurysm and splenic abscesses lead to poor prognosis and high mortality rate as high as 50% due to delayed/missed diagnosis. We describe an attempt to identify Burkholderia pseudomallei immediately, which was confirmed by polymerase chain reaction (PCR) and gene sequence analysis of 23S rRNA gene. PCR is not only an unambiguous identification of B. pseudomallei but also a rapid detection because B. pseudomallei may not be readily isolated. For patients of melioidosis abdominal aortic aneurysm with spleen abscess, prolonged antibiotic therapy, splenectomy and artificial vessel replacement provided an excellent result in our study. The progression, roentgenographic findings and histopathology character of melioidosis are similar to those of tuberculosis disease. PCR is useful to differentiate B. pseudomallei from Mycobacterium tuberculosis.


Assuntos
Aneurisma Infectado/microbiologia , Aneurisma da Aorta Abdominal/microbiologia , Burkholderia pseudomallei/genética , Melioidose/microbiologia , Reação em Cadeia da Polimerase , RNA Bacteriano/genética , RNA Ribossômico 23S/genética , Ribotipagem , Abscesso Abdominal/diagnóstico , Abscesso Abdominal/microbiologia , Aneurisma Infectado/diagnóstico por imagem , Aneurisma Infectado/cirurgia , Aneurisma da Aorta Abdominal/diagnóstico por imagem , Aneurisma da Aorta Abdominal/cirurgia , Implante de Prótese Vascular , Humanos , Masculino , Melioidose/diagnóstico , Melioidose/cirurgia , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Esplenopatias/diagnóstico , Esplenopatias/microbiologia
14.
BMC Cardiovasc Disord ; 20(1): 28, 2020 03 24.
Artigo em Inglês | MEDLINE | ID: mdl-32209051

RESUMO

BACKGROUND: In the workup of a pediatric patient with pericarditis we found evidence of a pseudo-aneurysm of the left ventricle, which is a rare complication of purulent pericarditis. CASE PRESENTATION: We present a case of a six-year-old girl who was diagnosed with pericarditis and a fistula between the pericardial and the intra-luminal space of the left ventricle of the heart. She was successfully treated with antibiotics and cardio-thoracic surgery. We found 23 published cases (21 with follow-up) of infectious pseudo-aneurysm of the heart, of which 19 underwent surgery, 5 had fatal outcome, and 2 who refused surgery survived. The majority of cases were associated with Staphylococcus aureus. The exact mechanisms of this rare complication remain unknown. CONCLUSIONS: A pseudo-aneurysm of the left ventricle is a rare and not well understood complication of a purulent pericarditis most commonly caused by Staphylococcus aureus infection. Because of risk of rupture, surgical intervention is advised.


Assuntos
Falso Aneurisma/microbiologia , Aneurisma Infectado/microbiologia , Neoplasias Cardíacas/microbiologia , Osteomielite/microbiologia , Pericardite/microbiologia , Infecções Estafilocócicas/microbiologia , Falso Aneurisma/diagnóstico por imagem , Falso Aneurisma/terapia , Aneurisma Infectado/diagnóstico por imagem , Aneurisma Infectado/terapia , Antibacterianos/uso terapêutico , Procedimentos Cirúrgicos Cardíacos , Criança , Feminino , Neoplasias Cardíacas/diagnóstico por imagem , Neoplasias Cardíacas/terapia , Humanos , Osteomielite/complicações , Osteomielite/diagnóstico , Osteomielite/terapia , Pericardite/diagnóstico por imagem , Pericardite/terapia , Infecções Estafilocócicas/complicações , Infecções Estafilocócicas/diagnóstico , Infecções Estafilocócicas/terapia , Resultado do Tratamento
15.
Ann Vasc Surg ; 67: 59-66, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32209403

RESUMO

BACKGROUND: Primary mycotic aneurysm of the aorta (MAA) is a rare and potentially life-threatening disease. Endovascular aneurysm repair (EVAR) of MAAs involving the paravisceral aorta has been rarely reported. The purpose of this study is to report our experience with chimney EVAR (CHEVAR) in patients with MAAs involving the paravisceral aorta. METHODS: We performed a retrospective review of all patients treated with EVAR at our institution during the years 2009-2019. Of those, we identified the patients who were treated with CHEVAR for MAAs. Diagnosis of MAAs was based on clinical presentation, abnormal laboratory results, and a computed tomography scan suggestive of a MAA. The data collected included patient demographics, clinical presentation, the antibiotic regimen before and after the surgery, preoperative imaging, surgical details, and perioperative and long-term morbidity and mortality. RESULTS: During the study period, we performed 54 cases of CHEVARs for aortic aneurysms. Of those, 8 (15%) were performed for mycotic aneurysms involving the visceral segment. Six (75%) were men, and the mean age was 68 years (range: 59-76). All patients were symptomatic at the time of diagnosis, presenting with either back or abdominal pain. A total of 16 visceral vessels (celiac trunk, 2; superior mesenteric artery, 7; right renal artery, 4; and left renal artery, 3) were revascularized with parallel grafts (PGs). Six patients required 2 PGs, 1 patient required 3 PGs, and 1 patient had a single PG inserted. Fifteen (94%) PGs were upward-pointing chimney stent grafts, and 1 was placed in a downward-pointing "periscope" configuration. Eight visceral arteries in 6 patients were sacrificed, either by preoperative occlusion or intentional coverage with the endograft during the procedure. The vessels sacrificed included 4 celiac trunks and 4 renal arteries (3 main branches and 1 accessory renal artery). Technical success was achieved in all patients. One patient expired in the perioperative period. One patient developed an infection-related complication. One patient experienced worsening of his renal function and eventually required dialysis. Of the 4 patients who underwent intentional sacrifice of a kidney, all experienced a moderate decrease in renal function from the baseline ( mean preoperative and postoperative serum creatinine 0.76 mg/dL and 1.2 mg/dL, respectively, increase of 43%). The mean follow-up was 8 months (range: 3-28 months). During this period, 2 patients expired, 1 from an aneurysm-related cause. No stent occlusion of the PGs occurred and no reintervention due to endoleaks was required. No patient required explanation of the stent grafts or conversion to an open repair. CONCLUSIONS: CHEVAR is a feasible and safe treatment modality for MAAs involving the visceral segment. Occasionally, intentional occlusion of the selected visceral arteries may be required to minimize the risk of gutter endoleaks in this urgent setting. Further follow-up is needed to accurately assess the durability of this repair.


Assuntos
Aneurisma Infectado/cirurgia , Aneurisma Aórtico/cirurgia , Implante de Prótese Vascular , Procedimentos Endovasculares , Idoso , Aneurisma Infectado/diagnóstico por imagem , Aneurisma Infectado/microbiologia , Aneurisma Aórtico/diagnóstico por imagem , Aneurisma Aórtico/microbiologia , Prótese Vascular , Implante de Prótese Vascular/efeitos adversos , Implante de Prótese Vascular/instrumentação , Bases de Dados Factuais , Procedimentos Endovasculares/efeitos adversos , Procedimentos Endovasculares/instrumentação , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/terapia , Estudos Retrospectivos , Fatores de Risco , Stents , Fatores de Tempo , Resultado do Tratamento
16.
Ann Vasc Surg ; 67: 566.e5-566.e9, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32209412

RESUMO

BACKGROUND: Endovascular stent and prosthetic graft placement are commonplace techniques for correction of subclavian artery (SCA) lesions. However, when initial surgical repair of the SCA becomes complicated by subsequent infection or thrombosis of the repair site, stents and prosthetic grafts are no longer suitable for secondary repair due to the risk of recurrent failure and limited longevity. Autogenous tissue is more resistant to infection and has improved long-term patency, and thus may be a better option for secondary reconstruction in these complex clinical scenarios. The most commonly used autogenous conduit for SCA reconstruction is the great saphenous vein; however, the significant size mismatch makes this unsuitable in many circumstances. The autogenous femoral vein is a promising alternative conduit for SCA repair. Here we present 3 successful cases of its use as a salvage technique following iatrogenic complications of prior surgical repair. METHODS: From 2015 to 2019, 3 patients underwent harvest of the femoral vein for use in SCA repair, with 2 carotid-axillary bypasses and 1 carotid-subclavian bypass. Indications included a mycotic pseudoaneurysm secondary to an infected SCA stent, an SCA avulsion secondary to an infected carotid-subclavian bypass graft, and an occluded SCA stent in a young patient. Postoperative graft patency was monitored via clinical resolution of symptoms and maintenance of perfusion, intact pulses, and arterial duplex or computed tomography (CT) scan. RESULTS: All these patients had a good outcome following their procedures. Each had intact radial pulses immediately postoperatively and maintained normal perfusion to the upper extremity for the duration of follow-up, with bypass patency confirmed via CT scan or arterial duplex. The SCA repair also allowed for salvage of the upper extremity and symptomatic relief in all patients. None of the patients developed deep vein thrombosis in the donor extremity, and neither of the infected patients developed recurrent infection of the repair site. CONCLUSIONS: The success of these cases demonstrates that the autogenous femoral vein is an effective and safe option for SCA reconstruction. It is particularly useful for secondary salvage when prior surgical repair via standard techniques is complicated by infection or thrombosis, and when target vessel size precludes the use of the great saphenous vein. This is an excellent choice of conduit that vascular surgeons should consider for use in complex SCA repairs.


Assuntos
Falso Aneurisma/cirurgia , Aneurisma Infectado/cirurgia , Implante de Prótese Vascular , Procedimentos Endovasculares , Veia Femoral/transplante , Oclusão de Enxerto Vascular/cirurgia , Infecções Relacionadas à Prótese/cirurgia , Artéria Subclávia/cirurgia , Adolescente , Falso Aneurisma/diagnóstico por imagem , Falso Aneurisma/microbiologia , Aneurisma Infectado/diagnóstico por imagem , Aneurisma Infectado/microbiologia , Autoenxertos , Prótese Vascular/efeitos adversos , Implante de Prótese Vascular/efeitos adversos , Implante de Prótese Vascular/instrumentação , Procedimentos Endovasculares/efeitos adversos , Procedimentos Endovasculares/instrumentação , Feminino , Oclusão de Enxerto Vascular/diagnóstico por imagem , Oclusão de Enxerto Vascular/etiologia , Humanos , Masculino , Pessoa de Meia-Idade , Infecções Relacionadas à Prótese/diagnóstico por imagem , Infecções Relacionadas à Prótese/microbiologia , Stents/efeitos adversos , Artéria Subclávia/diagnóstico por imagem , Resultado do Tratamento
17.
Ann Vasc Surg ; 67: 567.e5-567.e8, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32209413

RESUMO

We present the unusual case of a mycotic right common iliac artery pseudoaneurysm caused by the methicillin-susceptible Staphylococcus aureus (MSSA) of indeterminate etiology in a healthy 57-year-old man with no risk factors for infection, trauma, or malignancy. The patient initially presented with worsening subacute right lower quadrant pain and was found to have a pseudoaneurysm of the right common iliac artery. Given concern for rupture on a computed tomography angiogram (CTA), he underwent exclusion of the pseudoaneurysm with a covered stent. At the time of presentation, he had no signs or symptoms of infection. However, the patient developed fever, chills, and worsening right lower quadrant pain 13 days after the index operation and was found to have a leukocytosis, blood cultures positive for MSSA, and progressive soft-tissue changes involving the right common iliac artery on CTA consistent with infection. He was definitively treated with stent explantation, aggressive debridement and replacement with an in situ cryopreserved bypass, and short-term suppressive antibiotic therapy.


Assuntos
Falso Aneurisma/microbiologia , Aneurisma Infectado/cirurgia , Aneurisma Ilíaco/microbiologia , Infecções Estafilocócicas/microbiologia , Falso Aneurisma/diagnóstico por imagem , Falso Aneurisma/cirurgia , Aneurisma Infectado/diagnóstico por imagem , Aneurisma Infectado/microbiologia , Antibacterianos/administração & dosagem , Implante de Prótese Vascular/instrumentação , Desbridamento , Remoção de Dispositivo , Procedimentos Endovasculares/instrumentação , Humanos , Aneurisma Ilíaco/diagnóstico por imagem , Aneurisma Ilíaco/cirurgia , Masculino , Pessoa de Meia-Idade , Infecções Estafilocócicas/diagnóstico por imagem , Infecções Estafilocócicas/cirurgia , Stents , Resultado do Tratamento
19.
BMJ Case Rep ; 13(2)2020 Feb 11.
Artigo em Inglês | MEDLINE | ID: mdl-32051162

RESUMO

A 67-year-old man with diabetes and hypertension presented with complaints of abdominal pain and lower back ache for 7 months, with intermittent episodes of fever. On examination, there was an expansile mass in the upper abdomen with bruit on auscultation. He also had tenderness in the L1-L2 vertebral space with paraspinal fullness, causing painful restriction of lower limb motor functions but without affecting sensation. On evaluation, he was found to have an abdominal aortic aneurysm with infective lumbar spondylodiscitis. The aspirate from the paravertebral infected tissue and cultures from blood grew Pseudomonas aeruginosa, a rare causative agent of mycotic aortic aneurysm. Whether the infective spondylitis spread to the abdominal aorta causing the mycotic aneurysm or vice versa is a dilemma in such a case. However, the mainstay of treatment remains adequate source control and repair of the aneurysm with appropriate antibiotic therapy. Our patient received intravenous antibiotics for P . aeruginosa based on sensitivity, following which he underwent debridement of the infective spondylodiscitis with aneurysmorrhaphy. He had an uneventful recovery and was well at 3-month follow-up.


Assuntos
Aneurisma Infectado/microbiologia , Aneurisma da Aorta Abdominal/microbiologia , Ceftazidima/uso terapêutico , Infecções por Pseudomonas/complicações , Espondilite/microbiologia , Idoso , Aneurisma Infectado/terapia , Antibacterianos/uso terapêutico , Aneurisma da Aorta Abdominal/terapia , Humanos , Masculino , Pseudomonas aeruginosa , Espondilite/terapia
20.
J Vasc Surg ; 72(2): 531-540, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32061482

RESUMO

OBJECTIVE: Mycotic aneurysms of the abdominal aorta (MAAA) can be treated by open repair (OR) or endovascular aneurysm repair (EVAR). This nationwide study provides an overview of the situation of MAAA treatment in The Netherlands in 2016. METHODS: A retrospective cohort study was conducted with all centers that registered aortic abdominal aneurysms in the Dutch Surgical Aneurysm Audit in 2016. Questionnaires on 1-year outcomes were sent to all centers that treated patients with MAAA. The primary aim was to determine 30-day and 1-year mortality and morbidity of OR- and EVAR-treated patients. Morbidity was determined by the need for reoperations and the number of readmissions to the hospital. RESULTS: Twenty-six MAAA were detected in the Dutch Surgical Aneurysm Audit database of 2016, resulting in an incidence of 0.7% of all registered abdominal aortic aneurysms. The 30-day mortality for OR and EVAR treated patients was 1 in 13 and 0 in 13, respectively. Major and minor reinterventions within 30 days were needed for two (one OR and one EVAR) and two (one OR and one EVAR) patients, respectively. Two patients (15.4%) in the OR group and one patient (7.7%) in the EVAR group were readmitted to hospital within 30 days. In total, 1-year outcomes of 23 patients were available. In the OR group, one patient (9.1%) died in the first postoperative year. There was one major reintervention (removal of endoprosthesis and spiralvein reconstruction) in the EVAR group. Two patients (18.2%) treated with OR and two (16.7%) treated with EVAR required a minor reintervention. In both groups, four patients (OR, 36.4%; EVAR, 33.3%) were readmitted to hospital within 1 year postoperatively. CONCLUSIONS: Both OR- and EVAR-treated patients show acceptable clinical outcomes after 30 days and at the 1-year follow-up. Depending on the clinical course of the patient, EVAR may be considered in the management of this disease.


Assuntos
Aneurisma Infectado/cirurgia , Aneurisma da Aorta Abdominal/cirurgia , Implante de Prótese Vascular , Procedimentos Endovasculares , Idoso , Aneurisma Infectado/diagnóstico por imagem , Aneurisma Infectado/microbiologia , Aneurisma Infectado/mortalidade , Antibacterianos/administração & dosagem , Aneurisma da Aorta Abdominal/diagnóstico por imagem , Aneurisma da Aorta Abdominal/microbiologia , Aneurisma da Aorta Abdominal/mortalidade , Implante de Prótese Vascular/efeitos adversos , Implante de Prótese Vascular/mortalidade , Esquema de Medicação , Procedimentos Endovasculares/efeitos adversos , Procedimentos Endovasculares/mortalidade , Feminino , Humanos , Incidência , Masculino , Auditoria Médica , Pessoa de Meia-Idade , Países Baixos/epidemiologia , Readmissão do Paciente , Complicações Pós-Operatórias/mortalidade , Complicações Pós-Operatórias/terapia , Sistema de Registros , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Fatores de Tempo , Resultado do Tratamento
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