title: Endovascular Management of Concomitant Thoracic and Abdominal Aortic Ruptures Resulting from Brucellosis Aortitis.
abstract: BACKGROUND
  Acute aortic symptomatology is an unusual manifestation of Brucella melitensis infection. We present a rare case of acute multifocal thoracic and abdominal aortic ruptures arising from Brucellosis aortitis managed exclusively with endovascular surgery.
  
  
  METHODS
  A 71-year-old Hispanic male with a history of atrial fibrillation and prior stroke on chronic anticoagulation presented with shortness of breath and malaise. In addition, he had been treated approximately 1 year previously in Mexico for B. melitensis bacteremia after eating fresh unpasteurized cheese. Computed tomography (CT) angiography demonstrated an acute rupture of the descending thoracic aorta just proximal to the celiac trunk and synchronous rupture at the abdominal aortic bifurctation.
  
  
  RESULTS
  The patient was taken emergently to the hybrid operating room, where synchronous supraceliac thoracic aorta and abdominal aortoiliac stent grafts were deployed under local anesthesia. Completion angiography demonstrated total exclusion of the thoracic and abdominal extravasation with no evidence of endoleak. Twenty hours postoperatively, the patient became acutely obtunded and hypotensive. Repeat CT angiography demonstrated contrast extravasation at the level of the excluded aortic bifurcation. Emergent angiography confirmed a type II endoleak with free extraluminal rupture. Multiple coils were placed at the level of the aortic bifurcation between the left limb of the stent graft and the aortic wall to tamponade the endoleak. No further extravasation was noted on final aortography. Postoperatively, blood cultures confirmed the diagnosis of B. melitensis. The patient was treated with systemic doxycycline, gentamicin, and rifampin. Resolution of the acute event occurred without additional sequelae and he was discharged from the hospital to a rehabilitation facility.
  
  
  CONCLUSIONS
  Concomitant multifocal aortic ruptures arising from Brucellosis aortic infection is a very rare event. In this case, the patient was successfully treated with thoracic and abdominal endovascular stent-graft exclusion, coiling, and long-term targeted antibiotics.
authors.affiliation: Division of Vascular and Endovascular Surgery, Department of Surgery, University of California, Irvine Medical Center, Orange, CA.
authors.forename: Samuel L
authors.initials: SL
authors.lastname: Chen
authors.affiliation: Division of Vascular and Endovascular Surgery, Department of Surgery, University of California, Irvine Medical Center, Orange, CA.
authors.forename: Isabella J
authors.initials: IJ
authors.lastname: Kuo
authors.affiliation: Division of Vascular and Endovascular Surgery, Department of Surgery, University of California, Irvine Medical Center, Orange, CA.
authors.forename: Roy M
authors.initials: RM
authors.lastname: Fujitani
authors.affiliation: Division of Vascular and Endovascular Surgery, Department of Surgery, University of California, Irvine Medical Center, Orange, CA. Electronic address: nkabutey@uci.edu.
authors.forename: Nii-Kabu
authors.initials: NK
authors.lastname: Kabutey
mesh_terms: D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D001012:Aorta, Abdominal / Q000000981:diagnostic imaging / Q000382:microbiology / Q000601:surgery*; D001013:Aorta, Thoracic / Q000000981:diagnostic imaging / Q000382:microbiology / Q000601:surgery*; D001019:Aortic Rupture / Q000000981:diagnostic imaging / Q000382:microbiology / Q000601:surgery*; D001025:Aortitis / Q000000981:diagnostic imaging / Q000382:microbiology / Q000601:surgery*; D001027:Aortography / Q000379:methods; D001431:Bacteriological Techniques; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects; D017347:Brucella melitensis / Q000302:isolation & purification*; D002006:Brucellosis / Q000000981:diagnostic imaging / Q000382:microbiology / Q000601:surgery*; D000072226:Computed Tomography Angiography; D004621:Embolization, Therapeutic; D057867:Endoleak / Q000209:etiology / Q000628:therapy; D057510:Endovascular Procedures / Q000009:adverse effects; D006801:Humans; D008297:Male; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents