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1.
J Radiol Case Rep ; 13(4): 17-27, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-31565178

RESUMO

Mycotic pseudoaneurysms usually arise from an infectious arteritis or mycotic aneurysms secondary to weakening and destruction of the arterial wall resulting in a contained rupture. We report a case of a mycotic pseudoaneurysm affecting the aortic isthmus of the thoracic aorta which is an extremely rare infection. To our knowledge no case report of mycotic pseudoaneurysm of the aortic isthmus secondary to salmonella infection has thus far been described. The specific case we present is also unique in that it posed a diagnostic imaging dilemma where the initial imaging revealed a periaortic mass which could not be accurately characterized and only on subsequent imaging reveal itself to be a thrombosed mycotic pseudoaneurysm. We hope that our case report highlights to the medical community the high degree of suspicion one should have regarding pseudoaneurysms when dealing with a complex mass intimately related to a vascular structure.


Assuntos
Falso Aneurisma/microbiologia , Aneurisma Infectado/microbiologia , Aneurisma da Aorta Torácica/microbiologia , Infecções por Salmonella/diagnóstico por imagem , Idoso de 80 Anos ou mais , Falso Aneurisma/diagnóstico por imagem , Aneurisma Infectado/diagnóstico por imagem , Aneurisma da Aorta Torácica/diagnóstico por imagem , Ruptura Aórtica/diagnóstico por imagem , Ruptura Aórtica/microbiologia , Aortografia , Angiografia por Tomografia Computadorizada , Humanos , Masculino
2.
Tidsskr Nor Laegeforen ; 139(12)2019 09 10.
Artigo em Norueguês | MEDLINE | ID: mdl-31502778

RESUMO

BACKGROUND: This case report presents one of the first documented incidents of chronic Q-fever (C. burnetii) in Norway. A comprehensive workup resulted in an unexpected finding. CASE PRESENTATION: A Norwegian woman in her eighties presented to a district general hospital with lower back pain, decreased general condition and weight loss. Computer tomography (CT) revealed a large thoracic aortic aneurysm presumed to be of mycotic origin, and later magnetic resonance imaging (MRI) scans revealed osteomyelitis in the surrounding vertebrae. Conventional diagnostic workup did not identify the causative agent. After more than 6 months of different examinations, surgery, exhausting invasive procedures and antimicrobial treatment, we were ultimately successful in determining the microbial cause of chronic mycotic aneurism and osteomyelitis to be C. Burnetii (Q-fever) through serological and PCR analysis. INTERPRETATION: An increasing proportion of the population in all age groups travel abroad, and clinicians should be aware of the increasing incidence of imported infectious diseases. Obtaining a thorough medical history is still an important tool in the diagnostic process.


Assuntos
Aneurisma da Aorta Torácica/microbiologia , Osteomielite/microbiologia , Febre Q , Idoso de 80 Anos ou mais , Antibacterianos/administração & dosagem , Antibacterianos/uso terapêutico , Aneurisma da Aorta Torácica/diagnóstico por imagem , Coxiella burnetii/isolamento & purificação , Feminino , Humanos , Dor Lombar/microbiologia , Vértebras Lombares/diagnóstico por imagem , Vértebras Lombares/microbiologia , Imagem por Ressonância Magnética , Anamnese , Noruega , Osteomielite/diagnóstico por imagem , Febre Q/complicações , Febre Q/diagnóstico , Febre Q/tratamento farmacológico , Vértebras Torácicas/diagnóstico por imagem , Vértebras Torácicas/microbiologia , Tomografia Computadorizada por Raios X , Doença Relacionada a Viagens , Perda de Peso
3.
J Cardiothorac Surg ; 14(1): 150, 2019 Aug 19.
Artigo em Inglês | MEDLINE | ID: mdl-31426817

RESUMO

BACKGROUND: Infected aortic arch aneurysms caused by Mycobacterium avium are rare in immunocompetent individuals. Promptly recognizing these aneurysms is important because delays in treatment result in aneurysm rupture and a high fatality rate. Although Salmonella species, Streptococcus species, Staphylococcus aureus, and S. epidermis are commonly found in immunocompetent individuals, to our knowledge, infected aortic arch aneurysms caused by M. avium have not yet been reported. CASE PRESENTATION: We report the case of a 63-year old immunocompetent man who underwent total arch replacement following infection by the nontuberculous mycobacteria M. avium. The procedure involved total aneurysmal resection and arch replacement with a rifampicin-bonded gelatin-sealed woven Dacron graft. He was discharged without complications and remained asymptomatic after 30 months. CONCLUSION: In this brief report, we outline and discuss the rare successful case of total arch replacement using total aneurysmal resection and rifampicin-bonded gelatin-sealed woven Dacron graft for an infected aortic arch aneurysm resulting from M. avium in an immunocompetent patient.


Assuntos
Aneurisma da Aorta Torácica/microbiologia , Aneurisma da Aorta Torácica/cirurgia , Infecções por Micobactéria não Tuberculosa/complicações , Infecções por Micobactéria não Tuberculosa/microbiologia , Complexo Mycobacterium avium , Prótese Vascular , Humanos , Masculino , Pessoa de Meia-Idade
5.
Cardiovasc Pathol ; 39: 5-7, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30513449

RESUMO

OBJECTIVES: The purpose of this case report is to document the occurrence of granulomatous aortitis complicated by formation of a saccular aneurysm and aortobronchial fistula due to Brucella infection. METHODS: A 65-year-old man with a history of feral swine hunting presented with hemoptysis and was found to have a saccular thoracic aortic aneurysm and associated aortobronchial fistula. The aneurysm underwent operative repair with closure of the aortobronchial fistula. RESULTS: Histopathological examination of the aneurysm wall revealed evidence of granulomatous aortitis. Cultures of the blood and aortic wall tissue were positive for Brucella suis. CONCLUSIONS: Although rare, Brucella infection should be considered in the differential diagnosis of aortic aneurysm with granulomatous aortitis.


Assuntos
Aneurisma Infectado/microbiologia , Aneurisma da Aorta Torácica/microbiologia , Aortite/microbiologia , Fístula Brônquica/microbiologia , Brucella suis/isolamento & purificação , Brucelose/microbiologia , Fístula Vascular/microbiologia , Idoso , Aneurisma Infectado/patologia , Aneurisma Infectado/terapia , Animais , Animais Selvagens/microbiologia , Antibacterianos/uso terapêutico , Aneurisma da Aorta Torácica/patologia , Aneurisma da Aorta Torácica/terapia , Aortite/patologia , Aortite/terapia , Técnicas Bacteriológicas , Biópsia , Implante de Prótese Vascular , Fístula Brônquica/patologia , Fístula Brônquica/terapia , Brucelose/patologia , Brucelose/terapia , Brucelose/transmissão , Desbridamento , Humanos , Masculino , Retalhos Cirúrgicos , Suínos/microbiologia , Resultado do Tratamento , Fístula Vascular/patologia , Fístula Vascular/terapia , Zoonoses
6.
Eur J Vasc Endovasc Surg ; 57(2): 239-246, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30340857

RESUMO

OBJECTIVE: Mycotic aortic aneurysms are rare, life threatening, and complex. This nationwide study aimed to assess outcome after repair of mycotic thoracic aortic aneurysms (MTAAs). METHODS: Patients treated in Sweden for MTAAs between 2000 and 2016 were identified in the Swedish vascular registry (2010-16) and local patient registries (2000-09). Primary outcome was survival, and secondary outcomes included surgical strategy, rate of infection related complications (IRC), and re-operations. RESULTS: Fifty-two patients (median age 71 ± 8.1 years; 28 [54%] men, 13 [25%] ruptured) were identified (3.6% of all thoracic aortic aneurysm repairs in Sweden). Aneurysm location was aortic arch (n = 6; 11%), descending aorta (n = 42; 81%), and multiple locations (n = 4; 8%). Twenty-nine (56%) patients had positive cultures; the most prevalent agent was Staphylococcus aureus (n = 16; 31%). Operative techniques included thoracic endovascular aortic repair (TEVAR; n = 35 [67%]), fenestrated/branched TEVAR (n = 8; 15%), hybrid repair (n = 7; 14%), and open patch repair (n = 2; 4%). Survival was 92% (95% confidence interval [CI] 88-96) at 30 days, 88% (95% CI 84-93) at three months, 78% (73-84) at one year, and 71% (64-77) at five years. The mean follow up among survivors (> 90 days) was 45 months (range 4-216 months). Antibiotics were administered for a median of 15 weeks (range 0-220 weeks). IRCs occurred in nine patients (17%): sepsis (n = 3), graft infection (n = 3), recurrent mycotic aneurysm (n = 1), aorto-oesophageal/bronchial fistula (n = 2). Six (67%) IRCs were fatal; 80% occurred within the first year. Re-operations were performed in nine patients (17%). CONCLUSIONS: TEVAR was often used as treatment for MTAAs, with acceptable short- and long-term survival when compared with open cohorts in the literature. IRCs are of concern and warrant follow up and long-term antibiotic treatment.


Assuntos
Aneurisma Infectado/cirurgia , Aneurisma da Aorta Torácica/microbiologia , Ruptura Aórtica/microbiologia , Procedimentos Endovasculares/métodos , Infecções Estafilocócicas/cirurgia , Idoso , Idoso de 80 Anos ou mais , Aneurisma Infectado/epidemiologia , Aneurisma da Aorta Torácica/epidemiologia , Aneurisma da Aorta Torácica/cirurgia , Ruptura Aórtica/epidemiologia , Ruptura Aórtica/cirurgia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Sistema de Registros , Reoperação/estatística & dados numéricos , Estudos Retrospectivos , Infecções Estafilocócicas/epidemiologia , Análise de Sobrevida , Suécia/epidemiologia , Resultado do Tratamento
7.
Kyobu Geka ; 71(12): 1023-1026, 2018 11.
Artigo em Japonês | MEDLINE | ID: mdl-30449871

RESUMO

A 69-year-old man was hospitalized urgently to the department of cardiology, with the progressive general malaise. On admission, his blood pressure was 80/42 mmHg, his white cell count 13,700/µl, and C-reactive protein 25.55 mg/dl suggesting existence of aggressive infection with impaired circulation. Massive pericardial effusion was detected in echocardiography. Pericardial drainage was undergone promptly. There was drainage of 700 ml and the property was purulent. Pneumococcus was detected by the culture test of the pericardial fluid. Antibiotic administration was started by a diagnosis of the purulent pericarditis. His general condition was improved. However, a rapidly expanding saccular aneurysm was found in a descending thoracic aorta by computed tomography( CT). As an infected thoracic aortic aneurysm secondary to the purulent pericarditis, we performed thoracic endovascular aneurysm repair (TEVAR). The intravenous administration of antibiotics was continued for 2 weeks after TEVAR, which was followed by oral antibiotic administration for 1 year. The aneurysm completely disappeared by CT, 10 months after TEVAR. In case with an infected thoracic aortic aneurysm, TEVAR can be a 1st choice of treatment, depending on a causative organism and the morphology of the aneurysm.


Assuntos
Aneurisma Infectado/etiologia , Aneurisma da Aorta Torácica/etiologia , Derrame Pericárdico/terapia , Pericardite/complicações , Idoso , Aneurisma Infectado/microbiologia , Aneurisma Infectado/terapia , Antibacterianos/uso terapêutico , Aorta Torácica , Aneurisma da Aorta Torácica/microbiologia , Aneurisma da Aorta Torácica/terapia , Proteína C-Reativa/análise , Drenagem/métodos , Humanos , Contagem de Leucócitos , Masculino , Derrame Pericárdico/diagnóstico por imagem , Derrame Pericárdico/microbiologia , Pericardite/microbiologia , Streptococcus pneumoniae/isolamento & purificação , Supuração/microbiologia , Supuração/terapia , Resultado do Tratamento
8.
Braz J Med Biol Res ; 51(9): e6864, 2018 Jun 25.
Artigo em Inglês | MEDLINE | ID: mdl-29947649

RESUMO

The mortality of patients with mycotic aneurysms is high, especially in East Asia, and infection by Salmonella species is the most common. Our study aimed to improve prognosis of adult mycotic aneurysms with early diagnosis and accurate treatment. Four adult patients with mycotic aneurysm caused by Salmonella were included and analyzed by single-center retrospective analysis. Cases reported in the literature during the past 10 years were also summarized. The average age of the 4 male patients was 61.25 years, while that of the 53 cases reported in the literature was 65.13 years. Hypertension, diabetes, and atherosclerosis were common complications. Most patients presented fever and experienced pain at the corresponding position of the aneurysm. Laboratory examination found an increased number of white blood cells accompanied by an increase in inflammatory markers. Most aneurysms were found in the abdominal aorta, while the rupture of an aneurysm was the most common complication. The mortality rates were 21.43 and 7.14% after open surgery or endovascular aneurysm repair (EVAR) intervention, respectively. The recurrence rates of infection were 0 and 17.85% for both treatments, respectively. The mortality rate of mycotic aneurysm caused by Salmonella infection was high in middle-aged males with hypertension, diabetes, and atherosclerosis. The possibility of a Salmonella-infected aneurysm should be considered in these high-risk groups presenting chills, fever, chest, and back pain. Open surgery was superior to EVAR treatment in the clearance of infected foci and the reduction of postoperative recurrence. The recurrence of postoperative infection can be prevented by intravenous antibiotic therapy for 6 weeks post-surgery.


Assuntos
Aneurisma Infectado/microbiologia , Aneurisma da Aorta Torácica/microbiologia , Infecções por Salmonella/complicações , Aneurisma Infectado/diagnóstico por imagem , Aneurisma Infectado/mortalidade , Antibacterianos/uso terapêutico , Aneurisma da Aorta Torácica/diagnóstico por imagem , Aneurisma da Aorta Torácica/tratamento farmacológico , Aneurisma da Aorta Torácica/mortalidade , Humanos , Masculino , Pessoa de Meia-Idade , Fatores de Risco , Salmonella/isolamento & purificação , Infecções por Salmonella/diagnóstico por imagem , Infecções por Salmonella/mortalidade , Tomografia Computadorizada por Raios X
9.
Vasc Endovascular Surg ; 52(6): 473-477, 2018 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-29716477

RESUMO

INTRODUCTION: Mycotic pseudoaneurysm has traditionally been repaired surgically with excision of the infected artery and revascularization via extra-anatomical or in situ bypass. There have been reports of endovascular repair for high-risk patients for formal surgical repair. We present a case of a patient with 3 large pseudoaneurysms arising from the right subclavian artery, descending thoracic aorta, and right popliteal artery treated with endovascular and hybrid intervention. CASE: A 74-year-old male with remote history of coronary artery bypass graft and recent sternoclavicular joint abscess developed 3 concurrent pseudoaneurysms arising from the right subclavian artery, distal descending thoracic aorta, and right popliteal artery. He underwent right axillary to common carotid bypass with endovascular stent graft placement in the distal innominate and proximal subclavian artery, and subsequently had thoracic endovascular aortic repair and right popliteal stent graft. Four months later, he presented with hemoptysis due to compression of the lung secondary to the pseudoaneurysm. He underwent right anterior thoracotomy and debridement of the pseudoaneurysm. Patient recovered from the procedure and discharged. CONCLUSION: Endovascular repair of mycotic pseudoaneurysm is an acceptable alternative for high-risk patients. Even when open approach became necessarily, endovascular stent graft decreased blood loss and morbidity.


Assuntos
Falso Aneurisma/cirurgia , Aneurisma Infectado/cirurgia , Aneurisma da Aorta Torácica/cirurgia , Implante de Prótese Vascular , Procedimentos Endovasculares , Artéria Poplítea/cirurgia , Artéria Subclávia/cirurgia , Idoso , Falso Aneurisma/diagnóstico por imagem , Falso Aneurisma/microbiologia , Aneurisma Infectado/diagnóstico por imagem , Aneurisma Infectado/microbiologia , Antibacterianos/uso terapêutico , Aneurisma da Aorta Torácica/diagnóstico por imagem , Aneurisma da Aorta Torácica/microbiologia , Aortografia/métodos , Prótese Vascular , Implante de Prótese Vascular/instrumentação , Angiografia por Tomografia Computadorizada , Procedimentos Endovasculares/instrumentação , Humanos , Masculino , Artéria Poplítea/diagnóstico por imagem , Artéria Poplítea/microbiologia , Stents , Artéria Subclávia/diagnóstico por imagem , Artéria Subclávia/microbiologia , Resultado do Tratamento
10.
Interact Cardiovasc Thorac Surg ; 27(5): 792-793, 2018 11 01.
Artigo em Inglês | MEDLINE | ID: mdl-29757367

RESUMO

Endovascular approach is now a safe and effective technique for the elective treatment of a thoraco-abdominal aneurysm. This technique has significantly reduced the morbi-mortality for elective surgery. Moreover, it can permit to treat patients with a high surgical risk who are not eligible for open surgery. The permanent availability of endovascular material opens the door for treating a complex emergency thoraco-abdominal aneurysm. Here, we present the case of an 81-year-old man who had a rapidly evolving salmonella-infected aortic thoraco-abdominal Type IV pseudoaneurysm. Total endovascular treatment using aortic endoprosthesis, chimneys for coeliac trunk and superior mesenteric artery and periscopes for renal arteries was performed and permitted to obtain the complete exclusion of the pseudoaneurysm. The patient was event free and discharged from hospital after a few days with an antibiotic treatment adapted for salmonella. He was still event free 10 months after surgery. Endovascular technique might be a viable option even for an emergency infected complex thoraco-abdominal aortic aneurysm. Secondary open surgery should be discussed under the benefit-risk balance.


Assuntos
Falso Aneurisma/cirurgia , Aneurisma da Aorta Torácica/cirurgia , Implante de Prótese Vascular/métodos , Procedimentos Endovasculares/métodos , Infecções por Salmonella/cirurgia , Salmonella/isolamento & purificação , Idoso de 80 Anos ou mais , Falso Aneurisma/diagnóstico , Falso Aneurisma/microbiologia , Aneurisma da Aorta Torácica/diagnóstico , Aneurisma da Aorta Torácica/microbiologia , Aortografia , Angiografia por Tomografia Computadorizada , Emergências , Humanos , Masculino , Infecções por Salmonella/diagnóstico , Infecções por Salmonella/microbiologia , Resultado do Tratamento
12.
Eur J Vasc Endovasc Surg ; 55(1): 92-100, 2018 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-29246434

RESUMO

OBJECTIVES: The outcome of endovascular repair (EVAR) for acute thoraco-abdominal aortic aneurysm (TAAA) is reported and the applicability of the t-Branch off the shelf (OTS) device is determined. METHODS: Interrogation of a prospectively maintained database identified all patients who underwent EVAR for acute TAAA between September 2012 (when the first non-elective t-Branch case was performed) and November 2015. Early and medium-term outcomes were analysed. Survival and re-intervention-free survival were calculated by Kaplan-Meier analysis. RESULTS: A total of 39 patients (27 men; mean ± SD age, 72 ± 8 years) were treated for acute symptomatic (n = 29) or ruptured (n = 10) TAAA (20 anatomical extent I-III, 19 extent IV). Fourteen patients had mycotic aneurysms. The mean aneurysm diameter was 80 ± 20 mm. The mean ± SD follow-up was 21.4 ± 15.4 months. Surgeon modified fenestrated EVAR was used in 24 patients, chimney/periscope EVAR in two, and t-Branch in 13 (33%) patients. Aortic coverage was greater than 40 mm above the coeliac axis in all patients. A total of 127 target vessels (TVs) were preserved (mean 3.3 per patient) and two occluded within 30 days. The 30 day mortality was 26%. Four (10%) patients developed spinal cord ischaemia (SCI): two with paraplegia died within 30 days, and two with paraparesis recovered completely with blood pressure manipulation and cerebrospinal fluid drainage. Estimated overall survival (±SD) at 12 and 24 months was 71.8 ± 7.2% and 63.2 ± 7.9%, respectively. Estimated freedom from re-intervention at 12 and 24 months was 93 ± 4.8% and 85.3 ± 6.8%, respectively. CONCLUSIONS: EVAR for acute TAAA is associated with acceptable early and mid-term results in patients who have no other treatment options. Only one third of these patients were suitable for the t-Branch device, indicating that further advances in device design are required to treat the majority of acute TAAA patients with commercially available OTS technology.


Assuntos
Aneurisma Infectado/cirurgia , Aneurisma da Aorta Torácica/cirurgia , Ruptura Aórtica/cirurgia , Procedimentos Endovasculares/métodos , Complicações Pós-Operatórias/epidemiologia , Doença Aguda/mortalidade , Idoso , Aneurisma Infectado/microbiologia , Aneurisma Infectado/mortalidade , Aneurisma da Aorta Torácica/microbiologia , Aneurisma da Aorta Torácica/mortalidade , Ruptura Aórtica/microbiologia , Ruptura Aórtica/mortalidade , Prótese Vascular , Procedimentos Endovasculares/instrumentação , Estudos de Viabilidade , Feminino , Seguimentos , Humanos , Isquemia/epidemiologia , Isquemia/etiologia , Estimativa de Kaplan-Meier , Masculino , Complicações Pós-Operatórias/etiologia , Estudos Prospectivos , Desenho de Prótese , Fatores de Risco , Medula Espinal/patologia , Stents , Resultado do Tratamento
13.
Eur J Vasc Endovasc Surg ; 54(4): 464-471, 2017 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-28826996

RESUMO

OBJECTIVE/BACKGROUND: Endovascular repair (EVAR) of mycotic aortic aneurysm (MAA) has become an alternative treatment for high risk patients. The aim of this study was to evaluate long-term survival and outcomes. METHODS: Retrospective analysis of 40 consecutive patients with MAAs undergoing EVAR and subsequent intravenous antibiotic treatment between September 2009 and April 2015. Follow-up was truncated on 30 April 2015. Uni- and multivariate logistic regression were used to assess risk factors of adverse outcomes. Cumulative survival was calculated using the Kaplan-Meier method. RESULTS: Median age at repair was 73 years (range 48-88 years) and 31 (77%) were men. Eleven (27%) patients were infected with Salmonella, 12 (30%) with non-Salmonella species, and 17 (42%) had negative cultures. Anatomical locations included the aortic arch/thoracic area in 10 (25%), the paravisceral area in seven (17%), and the infrarenal area in 23 (57%). Ten (25%) patients presented with aneurysm rupture and underwent emergency repair. Median follow-up was 25 months (range 1-69 months). Cumulative 1 and 5 year survival rates were 71% and 53%, respectively. Persistent or recurrent infection occurred in 20% (n = 8). Patients with persistent infection were treated with long-term medical therapy, but all died (75%; n = 6) within 6 months of repair. No survival difference was found between patients with or without Salmonella infections. However, there was a trend toward better survival in culture negative patients. CONCLUSION: EVAR of MAA is an acceptable alternative treatment of MAA. However, persistent infection after endovascular treatment does occur and is often fatal without surgical treatment.


Assuntos
Aneurisma Infectado/terapia , Antibacterianos/uso terapêutico , Aneurisma da Aorta Torácica/terapia , Procedimentos Endovasculares , Idoso , Idoso de 80 Anos ou mais , Aneurisma Infectado/diagnóstico , Aneurisma Infectado/mortalidade , Aneurisma da Aorta Torácica/microbiologia , Aneurisma da Aorta Torácica/mortalidade , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Taxa de Sobrevida , Resultado do Tratamento
14.
Ann Vasc Surg ; 45: 270.e7-270.e11, 2017 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-28743654

RESUMO

BACKGROUND: To demonstrate an ascending aortic tuberculosis pseudoaneurysm successfully treated with endografts under assistance of trans-apical body floss wiring technique and rapid ventricular pacing support. METHOD AND RESULT: A 77-year-old woman with a non-healing anteromedial chest wound presented with sudden hypotension and hemoptysis. The computed tomography (CT) scan revealed a 9-cm-diameter pseudoaneurysm of ascending aorta, with sternal erosion close to the wound. Conventional open repair was not preferred due to possible contamination of interposition graft and difficult sternum closure. The feasibility of endografting was confirmed based on appropriate landing zones. After endografts modification at back table, we made a left mini-thoracotomy and establish a through-and-through body floss wire from left ventricular apex to femoral artery. Retrograde delivery over this wire from femoral artery to ascending aorta and deployment of endografts under rapid ventricular pacing support were performed smoothly. Final angiography showed no endoleaks with patent coronary and arch vessels. Further wound debridement was done at the same time and wound culture yielded tuberculosis. After completing anti-tuberculosis therapy, no recurrent infection occurred. Postoperative 6-month CT scan disclosed optimal result. CONCLUSION: With adequate landing zones and delicate surgical strategy, endografting with anti-tuberculosis therapy may be an alternative treatment for ascending aortic tuberculosis pseudoaneurysm.


Assuntos
Falso Aneurisma/cirurgia , Aneurisma da Aorta Torácica/cirurgia , Implante de Prótese Vascular/métodos , Estimulação Cardíaca Artificial/métodos , Procedimentos Endovasculares/métodos , Tuberculose Cardiovascular/cirurgia , Idoso , Falso Aneurisma/diagnóstico por imagem , Falso Aneurisma/microbiologia , Antituberculosos/uso terapêutico , Aneurisma da Aorta Torácica/diagnóstico por imagem , Aneurisma da Aorta Torácica/microbiologia , Aortografia/métodos , Prótese Vascular , Implante de Prótese Vascular/instrumentação , Angiografia por Tomografia Computadorizada , Procedimentos Endovasculares/instrumentação , Feminino , Humanos , Desenho de Prótese , Resultado do Tratamento , Tuberculose Cardiovascular/diagnóstico por imagem , Tuberculose Cardiovascular/microbiologia
17.
Artigo em Inglês | MEDLINE | ID: mdl-28106966

RESUMO

Surgical treatment of mycotic aneurysm of the thoracic aorta is challenging because contamination from surrounding tissues may occur even after complete debridement with a prosthetic graft replacement of the aneurysm. This study describes the simple but very useful technique of using a pericardial fat flap to protect the prosthetic graft from reinfection.


Assuntos
Aneurisma Infectado/cirurgia , Aorta Torácica/cirurgia , Aneurisma da Aorta Torácica/cirurgia , Controle de Infecções/métodos , Pericárdio/cirurgia , Retalhos Cirúrgicos/transplante , Aneurisma Infectado/microbiologia , Aorta Torácica/patologia , Aneurisma da Aorta Torácica/microbiologia , Humanos , Artéria Torácica Interna/cirurgia , Artéria Torácica Interna/transplante , Omento , Período Pós-Operatório , Reimplante , Retalhos Cirúrgicos/irrigação sanguínea , Tomografia Computadorizada por Raios X , Enxerto Vascular/métodos
18.
Asian Cardiovasc Thorac Ann ; 25(2): 134-136, 2017 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-26424746

RESUMO

Infectious arteritis is an insidious condition commonly associated with a long diagnostic delay. We report the management of extensive pneumococcal thoracic aortitis in a 64-year-old woman. The frozen elephant trunk procedure was performed to repair the aortic arch. Prolonged aortic wall cultures were positive for Streptococcus pneumoniae. Late follow-up imaging at 36 months demonstrated no sign of recurrence around the hybrid vascular graft in the thoracic aorta.


Assuntos
Aneurisma Infectado/cirurgia , Aneurisma da Aorta Torácica/cirurgia , Aortite/cirurgia , Implante de Prótese Vascular/métodos , Infecções Pneumocócicas/cirurgia , Streptococcus pneumoniae/isolamento & purificação , Aneurisma Infectado/diagnóstico por imagem , Aneurisma Infectado/microbiologia , Antibacterianos/uso terapêutico , Aneurisma da Aorta Torácica/diagnóstico por imagem , Aneurisma da Aorta Torácica/microbiologia , Aortite/diagnóstico por imagem , Aortite/microbiologia , Aortografia/métodos , Angiografia por Tomografia Computadorizada , Feminino , Humanos , Pessoa de Meia-Idade , Infecções Pneumocócicas/diagnóstico por imagem , Infecções Pneumocócicas/microbiologia , Resultado do Tratamento
19.
J Infect Chemother ; 23(1): 62-64, 2017 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-27578027

RESUMO

Clostridium difficile generally causes enterocolitis by producing pathogenic toxins, while extraintestinal infections with C. difficile are extremely rare. Here we report the first documented case of an infective thoracic aortic aneurysm caused by nontoxic C. difficile that occurred after vascular interventions including endovascular aortic repair. The present case illustrates that endovascular interventions may expose patients to the rare infection by yielding the ischemic intestinal tract as an entry site for the pathogen into the bloodstream and providing an anaerobic environment inside the thrombosed aneurysm.


Assuntos
Aneurisma da Aorta Torácica/etiologia , Aneurisma da Aorta Torácica/microbiologia , Prótese Vascular/microbiologia , Clostridium difficile/isolamento & purificação , Idoso , Humanos , Masculino , Stents/microbiologia
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