Successful emergent endovascular repair of a ruptured mycotic thoracic aortic aneurysm.
BACKGROUND
Mycotic thoracic aortic aneurysms are a life-threatening diagnosis and carry a high risk of morbidity and mortality in the perioperative setting. Traditional open repair consists of debridement, drainage, and either in situ or extra-anatomic bypass. Acute rupture portends a dismal prognosis; however, emergent endovascular repair of ruptured mycotic aneurysms has been described in the literature and we present a case of successful endovascular treatment of a ruptured mycotic descending thoracic aortic aneurysm.


METHODS
We report the case of a 42-year-old male with hypertension and active intravenous drug use who presented with 3 weeks of chest pain, dyspnea, and hemoptysis, and on computed tomography scan was found to have a contained 4.1-cm ruptured mycotic thoracic aortic aneurysm. Blood cultures were positive for methicillin-resistant Staphylococcus aureus. Emergent repair was recommended because of likelihood of further rupture and death. Thoracic endovascular aortic repair (TEVAR) was performed using a rifampin-soaked stent graft without complication. At 2-year follow-up, the patient was asymptomatic and imaging demonstrated the stent graft in excellent position, without endoleak, and complete resolution of the aneurysm sac.


CONCLUSIONS
TEVAR can be safely employed to treat a ruptured mycotic thoracic aneurysm when open repair is not possible because of patient's comorbidity or complex rupture, as these patients face imminent death. Long-term follow-up is necessary for detection of endoleak, recurrence, or propagation of the aneurysm, and persistent bacterial infections.
Division of Vascular Surgery, Department of Surgery, University of Washington, Harborview Medical Center, Seattle, WA. Electronic address: rachelhn@uw.edu.
Rachel E
RE
Heneghan
Division of Vascular Surgery, Department of Surgery, University of Washington, Harborview Medical Center, Seattle, WA.
Niten
N
Singh
Division of Vascular Surgery, Department of Surgery, University of Washington, Harborview Medical Center, Seattle, WA.
Benjamin W
BW
Starnes
D000328:Adult; D000785:Aneurysm, Infected / Q000175:diagnosis / Q000382:microbiology / Q000601:surgery*; D000900:Anti-Bacterial Agents / Q000008:administration & dosage; D017545:Aortic Aneurysm, Thoracic / Q000175:diagnosis / Q000382:microbiology / Q000601:surgery*; D001027:Aortography / Q000379:methods; D001807:Blood Vessel Prosthesis; D019917:Blood Vessel Prosthesis Implantation / Q000295:instrumentation; D020099:Coated Materials, Biocompatible; D004630:Emergencies; D057510:Endovascular Procedures / Q000295:instrumentation; D006801:Humans; D008297:Male; D055624:Methicillin-Resistant Staphylococcus aureus / Q000302:isolation & purification*; D011474:Prosthesis Design; D012293:Rifampin / Q000008:administration & dosage; D013203:Staphylococcal Infections / Q000175:diagnosis / Q000382:microbiology / Q000601:surgery*; D015607:Stents; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
D000900:Anti-Bacterial Agents; D020099:Coated Materials, Biocompatible; D012293:Rifampin