[Selective embolization of mycotic aneurysm of the branches of the abdominal aorta].
We report two cases of multiple aneurysm complicating bacterial endocarditis and involving the hepatic, renal and superior mesenteric arteries. The aneurysms were treated by the superselective embolization technique hitherto restricted to cerebral arteries. The first patient had been operated upon for mitral valve endocarditis. Because of a persistent anicteric cholestasis, repeat ultrasonography and computerized tomographic scan were performed which revealed two intrahepatic aneurysms associated, at arteriography, with an aneurysm of the superior mesenteric artery. The patient underwent superselective embolization of one of the intrahepatic aneurysms, then of the superior mesenteric artery aneurysm. Angiographic cure was obtained and persists after a 17-month follow-up. In the second patient, persistent clinical and biochemical hepatic abnormalities after mitral and aortic valve replacements for endocarditis prompted us to perform an ultrasonography which showed a large hepatic aneurysm, and an abdominal arteriography which disclosed the presence of several aneurysms. Because of its size and suspected fissuration, the hepatic aneurysm was treated by superselective embolization, and this was followed by embolization of a renal artery. The immediate post-treatment period was uneventful, and complete angiographic cure was confirmed after 6 months. Superselective embolization seems to give good results at mid-term and should therefore be considered for fragile patients with multiple abdominal aneurysms.
Charlier
P
P
Service de cardiologie, hôpital Bichat, Paris.
Cohen
A
A
Eiferman
C
C
Reizine
D
D
Juliard
J M
JM
Merland
J J
JJ
D000328:Adult; D000785:Aneurysm, Infected / Q000601:surgery / Q000628:therapy*; D001012:Aorta, Abdominal; D001014:Aortic Aneurysm / Q000601:surgery / Q000628:therapy*; D004621:Embolization, Therapeutic; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged
Embolisations sélectives d'anévrysmes mycotiques des branches de l'aorte abdominale.