Aortitis following percutaneous aortic side branch embolization prior to endovascular repair of infrarenal aortic aneurysm.
OBJECTIVE
To report two cases of life-threatening aortic infection after percutaneous endovascular coil embolization prior to endovascular abdominal aortic aneurysm (AAA) repair (EVAR).


METHODS
Two 76-year-old patients were readmitted 5 days and 3 weeks, respectively, after technically successful percutaneous coil embolization of aortic side branches in advance of scheduled EVAR. In the first patient, the right hypogastric artery, the inferior mesenteric artery (IMA), and a lumbar artery had been embolized, whereas in the second patient only the right hypogastric artery and the IMA had been occluded. On admission, both patients presented with severe abdominal pain. Investigations revealed acute aortic infection in both patients, combined with substantial AAA enlargement in one. Open surgical infrarenal aortic replacement was performed using homografts, and antibiotic therapy was initiated. After uneventful recovery, both patients were asymptomatic, had intact aortic homografts, and showed no evidence of infection after 12 and 18 months of follow-up, respectively.


CONCLUSIONS
Endovascular infections are a potentially serious complication following percutaneous coil embolization of major aortic branches. Early diagnosis and dedicated therapy are mandatory. Immediate resection of the infected aorta and replacement with homografts in association with prolonged antibiotic treatment showed good midterm results.
Department of Cardiovascular Surgery, Swiss Cardiovascular Center, University Hospital, Bern, Switzerland.
Florian
F
Dick
Nicolas
N
Diehm
Martin
M
Gerber
Matthias K
MK
Widmer
Dai-Do
DD
Do
Juergen
J
Triller
Thierry
T
Carrel
Juerg
J
Schmidli
D000368:Aged; D000785:Aneurysm, Infected / Q000000981:diagnostic imaging / Q000382:microbiology* / Q000628:therapy; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D017544:Aortic Aneurysm, Abdominal / Q000150:complications / Q000000981:diagnostic imaging / Q000628:therapy*; D001025:Aortitis / Q000000981:diagnostic imaging / Q000382:microbiology* / Q000628:therapy; D019917:Blood Vessel Prosthesis Implantation; D003131:Combined Modality Therapy; D004621:Embolization, Therapeutic / Q000009:adverse effects*; D005260:Female; D006801:Humans; D008297:Male; D011425:Propionibacterium acnes / Q000302:isolation & purification; D016659:Psoas Abscess / Q000000981:diagnostic imaging / Q000382:microbiology* / Q000628:therapy; D012867:Skin / Q000382:microbiology*; D013210:Staphylococcus / Q000302:isolation & purification; D013291:Streptococcus / Q000302:isolation & purification; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
D000900:Anti-Bacterial Agents