title: Staged open, endovascular, and hybrid repair of concomitant mycotic aneurysms.
abstract: Primary mycotic aneurysms of the aorta are a rare but life-threatening condition. A 59-year-old woman developed a back abscess secondary to an insect bite. A computed tomography scan revealed 3 concomitant mycotic aneurysms, including a rupture. Staged repair was undertaken: immediate open repair for contained rupture of a type IV thoracoabdominal aortic aneurysm, followed by endovascular repair of a descending thoracic aneurysm 3 weeks later and finally an aortic arch hybrid repair of a left subclavian artery aneurysm 16 months later. She remains well postoperatively. There is currently no consensus on the timing of repair or modality of treatment of mycotic aneurysms. Each patient should be treated individually based on aneurysm location, rupture, and comorbidities, as shown by this case.
authors.affiliation: Imperial Vascular Unit, St. Mary's Hospital, Imperial College Healthcare NHS Trust, London, UK.
authors.forename: Anisha H
authors.initials: AH
authors.lastname: Perera
authors.affiliation: Department of Interventional Radiology, St. Mary's Hospital, Imperial College Healthcare NHS Trust, London, UK.
authors.forename: Elika
authors.initials: E
authors.lastname: Kashef
authors.affiliation: Imperial Vascular Unit, St. Mary's Hospital, Imperial College Healthcare NHS Trust, London, UK. Electronic address: r.gibbs@imperial.ac.uk.
authors.forename: Richard G J
authors.initials: RG
authors.lastname: Gibbs
mesh_terms: D000785:Aneurysm, Infected / Q000175:diagnosis / Q000382:microbiology / Q000601:surgery*; D017544:Aortic Aneurysm, Abdominal / Q000175:diagnosis / Q000382:microbiology / Q000601:surgery*; D017545:Aortic Aneurysm, Thoracic / Q000175:diagnosis / Q000382:microbiology / Q000601:surgery*; D001019:Aortic Rupture / Q000175:diagnosis / Q000382:microbiology / Q000601:surgery*; D001027:Aortography / Q000379:methods; D016866:Bacteroidaceae Infections / Q000175:diagnosis / Q000382:microbiology / Q000601:surgery*; D019917:Blood Vessel Prosthesis Implantation; D057510:Endovascular Procedures; D005260:Female; D006801:Humans; D007299:Insect Bites and Stings / Q000150:complications*; D008875:Middle Aged; D011008:Pneumococcal Infections / Q000175:diagnosis / Q000382:microbiology / Q000601:surgery*; D018720:Prevotella / Q000302:isolation & purification*; D013296:Streptococcus pneumoniae / Q000302:isolation & purification*; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome