title: Visceral debranching and aortic endoprosthesis for a suspected mycotic pseudoaneurysm of the abdominal aorta involving visceral arteries.
abstract: Celiac aortic localization of mycotic pseudoaneurysm is serious. The conventional treatment, resection of infected tissues with in situ revascularization, is associated with a high surgical morbid-mortality rate. We report a case of mycotic pseudoaneurysm of the abdominal aorta involving visceral arteries excluded by an aortic endoprosthesis after visceral debranching. A 69-year-old man developed a celiac mycotic pseudoaneurysm after an acute prostatitis with septicemia (Escherichia coli). He underwent celiac aortic exclusion by an aortic endoprosthesis associated with a retrogade visceral bypass at the same time, under adequate antibiotherapy. Postoperative course was uneventful. After 18-months of follow-up, he was asymptomatic without signs of infection. Hybrid procedure for mycotic celiac aortic pseudoaneurysm seems to be a complementary technique to conventional open repair, especially in emergency. Endovascular approach does not preclude conversion toward conventional surgery, if necessary. This case report raises the matter of aortic endoprosthesis in infected area, the duration of suppressive antibiotherapy, and the conversion in open repair.
authors.affiliation: Department of Vascular Surgery, CHU Tours, Cédex, France.
authors.forename: Mathilde
authors.initials: M
authors.lastname: Soule
authors.forename: Isabelle
authors.initials: I
authors.lastname: Javerliat
authors.forename: Antoine
authors.initials: A
authors.lastname: Rouanet
authors.forename: Anne
authors.initials: A
authors.lastname: Long
authors.forename: Patrick
authors.initials: P
authors.lastname: Lermusiaux
mesh_terms: D000368:Aged; D017541:Aneurysm, False / Q000000981:diagnostic imaging / Q000382:microbiology / Q000601:surgery*; D000785:Aneurysm, Infected / Q000000981:diagnostic imaging / Q000382:microbiology / Q000601:surgery*; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D017544:Aortic Aneurysm, Abdominal / Q000000981:diagnostic imaging / Q000382:microbiology / Q000601:surgery*; D001027:Aortography / Q000379:methods; D001807:Blood Vessel Prosthesis; D019917:Blood Vessel Prosthesis Implantation / Q000295:instrumentation*; D004926:Escherichia coli / Q000302:isolation & purification; D006801:Humans; D008297:Male; D011474:Prosthesis Design; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D014781:Viscera / Q000098:blood supply*
chemical_list: D000900:Anti-Bacterial Agents