title: Endovascular management of ruptured, mycotic abdominal aortic aneurysm.
abstract: Patients with mycotic aneurysms have a high mortality rate. The standard surgical approach can be exceptionally difficult and fraught with complications. There has been reluctance to insert an endograft into an infected field. We believe that this thought should be challenged and present a case of a successful endovascular repair of a ruptured, mycotic abdominal aortic aneurysm. The patient is a 63-year-old man with severe medical comorbidities and methicillin-sensitive Staphylococcus aureus. He required 6 units of red blood cells on admission. Magnetic resonance angiography (MRA) showed a contained rupture of his distal abdominal aorta, and he underwent emergent endovascular repair. An aortomono-iliac device (12 mm x 10 cm iliac extension limb) was inserted along with coil embolization of his right common iliac artery and a femoral-femoral bypass. He did not require additional transfusions after the procedure and was discharged in good condition. He is on antibiotics and doing well 1 year post-op. Endovascular management of ruptured, mycotic aneurysms is feasible. In fact, it is an attractive approach for a medically compromised patient subset that would carry an exceptionally high mortality rate with traditional surgical repair. Further follow-up is necessary to determine its long-term efficacy.
authors.affiliation: Division of Vascular Surgery, Department of Surgery, Emory University School of Medicine, Atlanta, Georgia , USA.
authors.forename: J Eduardo
authors.initials: JE
authors.lastname: Corso
authors.forename: Karthikeshwar
authors.initials: K
authors.lastname: Kasirajan
authors.forename: Ross
authors.initials: R
authors.lastname: Milner
mesh_terms: D000785:Aneurysm, Infected / Q000000981:diagnostic imaging / Q000628:therapy*; D017542:Aneurysm, Ruptured / Q000000981:diagnostic imaging / Q000628:therapy*; D017544:Aortic Aneurysm, Abdominal / Q000000981:diagnostic imaging / Q000628:therapy*; D021721:Balloon Occlusion / Q000295:instrumentation* / Q000379:methods; D003422:Critical Care / Q000379:methods; D016638:Critical Illness; D005500:Follow-Up Studies; D006801:Humans; D018810:Magnetic Resonance Angiography; D008297:Male; D008875:Middle Aged; D011859:Radiography; D018570:Risk Assessment; D013211:Staphylococcus aureus / Q000302:isolation & purification*; D015607:Stents; D016896:Treatment Outcome