Multiple HIV-related aneurysms: open and endovascular treatment.
OBJECTIVE
To report successful endovascular repair of thoracic aortic aneurysms in 2 patients with human immunodeficiency virus (HIV).


METHODS
Thoracic and abdominal aortic aneurysms (AAA) were found in a 60-year-old woman 1 year after she was diagnosed with HIV. Because of pain and risk of rupture, the AAA was repaired with conventional open techniques in February 1997, while the thoracic aneurysm was excluded in a staged procedure using a homemade endograft delivered through a 10-mm conduit sewn to the aortic tube graft. Two months later, new aneurysms were found in the superficial femoral arteries bilaterally; both were excised and replaced with vein grafts. After 7 years, the patient is well and no longer takes antiretroviral medication. Surveillance imaging shows continued patency of the stent-graft without evidence of leak or migration. In a more contemporary case, a 46-year-old man was found to have 5 focal aneurysms in the aorta; the most proximal descending thoracic aneurysm increased 2 cm in 2 weeks. The two thoracic aneurysms were successfully excluded using 2 Excluder stent-grafts. At 7 months, he was doing well, and the aneurysm had shrunk 11 mm.


CONCLUSIONS
Endovascular and open treatment of HIV-related aneurysms is possible, with excellent long-term results. Patients with long-life expectancy should be treated according to the same guidelines as patients without HIV.
Heikkinen
Maarit A
MA
Division of Vascular Surgery, Stanford University, Medical Center, Stanford, California 94305-5642, USA. mheik@netti.fi
Dake
Michael D
MD
Alsac
Jean-Marc
JM
Zarins
Christopher K
CK
D000785:Aneurysm, Infected / Q000601:surgery* / Q000821:virology; D017546:Angioscopy / Q000379:methods*; D017544:Aortic Aneurysm, Abdominal / Q000175:diagnosis / Q000601:surgery* / Q000821:virology; D017545:Aortic Aneurysm, Thoracic / Q000175:diagnosis / Q000601:surgery* / Q000821:virology; D001027:Aortography; D019917:Blood Vessel Prosthesis Implantation / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D006678:HIV / Q000276:immunology; D015483:HIV Antibodies / Q000276:immunology; D015658:HIV Infections / Q000821:virology*; D006801:Humans; D007813:Laparotomy / Q000379:methods*; D018810:Magnetic Resonance Angiography; D008297:Male; D008875:Middle Aged; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
D015483:HIV Antibodies