Successful emergent endovascular repair of a ruptured mycotic thoracic aortic aneurysm

Annals of Vascular Surgery
Rachel E HeneghanBenjamin W Starnes

Abstract

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. 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. TEVAR ...Continue Reading

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Citations

Jul 17, 2016·Vascular and Endovascular Surgery·Niti ShahiBabak Abai
Jan 20, 2017·Texas Heart Institute Journal·Ahmet DolapogluJoseph S Coselli
Nov 13, 2019·BMC Infectious Diseases·Tzu-Chi WuChun-Bin Tung
Jul 28, 2020·Journal of Vascular Surgery Cases and Innovative Techniques·Scott S Berman, Joseph S Sabat

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