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      Aneurisma micótico aórtico con invasión duodenal Translated title: Mycotic abdominal aorta aneurysm with duodenal invasion

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          Abstract

          Resumen Introducción: el aneurisma aórtico nicótico resulta de la dilatación de la pared arterial de la aorta a causa de una infección generalmente bacteriana. Es una patología poco frecuente pero mortal. Caso clínico: presentamos el caso de un varón de 94 años que fue diagnosticado de un aneurisma micótico de aorta abdominal con invasión duodenal mediante tomografía computarizada. Discusión: la presentación clásica de esta patología es una masa dolorosa, pulsátil y creciente con síntomas sistémicos de infección. La angiografía por tomografía computarizada diagnostica definitivamente el aneurisma. El tratamiento es una combinación de antibioticoterapia y resección quirúrgica activa. Pese a ello tiene muy mal pronóstico.

          Translated abstract

          Abstract Introduction: the mycotic aortic aneurysm results from the dilatation of aorta arterial wall because of an infection mostly caused by bacteria. It is a non-frequent but easily mortal disease. Case report: we present the case of a 94-year-old man who was diagnosed with a mycotic aneurysm of the abdominal aorta with duodenal invasion by computed tomography. Discussion: the classic presentation of this pathology is a painful, pulsatile, and enlarging mass with systemic symptoms of infection. Computed Tomography Angiography definitively diagnoses the aneurysm. The treatment is a combination of antibiotic therapy and active surgical resection, but it has a very bad prognosis.

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          Primary infected abdominal aortic aneurysm: surgical procedures, early mortality rates, and a survey of the prevalence of infectious organisms over a 30-year period.

          The purpose of this study was to analyze the surgical procedures, culture results, and outcomes, and to survey the prevalence of the infectious organisms over a 30-year period in patients with a primary infected abdominal aortic aneurysm (PIAAA). A total of 11 patients (1.8%) with PIAAA were surgically treated between 1982 and June 2009. All patients had back pain, leukocytosis, and elevated C-reactive protein level. All of the patients underwent either urgent or emergency operations. Cultures of aortic wall specimens and blood were positive in 10 patients and included Salmonella in 2, Streptococcus in 2, Campylobacter fetus in 2, and Listeria, Haemophilus influenzae, Serratia marcescens, Bacteroides thetaiotaomicron, and an unknown organism in 1 patient each. The 10 patients underwent in situ prosthetic grafting with excision of the infected tissue and lavage using 10 l saline solution; omentum plasty was required in four patients. An axillofemoral bypass was performed in one patient with pus surrounding the AAA. All 10 patients with in situ replacement survived and were administered intravenous antibiotic therapy for 1 month postoperatively. All of these patients left the hospital without any further complications. However, one patient who underwent an axillofemoral bypass died of overwhelming sepsis. In situ replacement with excision of infected tissue, lavage using 10 l saline solution, and omentum plasty for PIAAA successfully resolved the condition. High local concentrations of rifampin-soaked grafts or superficial femoral vein may also be an alternative for an in situ replacement conduit.
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            Outcomes of Open Repair of Mycotic Aortic Aneurysms with In Situ Replacement

            Background Mycotic aortic aneurysms are rare and life-threatening. Unfortunately, no established guidelines exist for the treatment of patients with mycotic aortic aneurysms. The purpose of this study was to evaluate the midterm outcomes of the open repair of mycotic thoracic and thoracoabdominal aneurysms and suggest a therapeutic strategy. Methods From 2006 to 2016, 19 patients underwent open repair for an aortic aneurysm. All infected tissue was extensively debrided and covered with soft tissue. We recorded the clinical findings, anatomic location of the aneurysm, bacteriology results, antibiotic therapy, morbidity, and mortality for these cases. Results The median age was 62±7.2 years (range, 16 to 78 years), 13 patients (68%) were men, and the mean aneurysm size was 44.5±4.9 mm. The mean time from onset of illness to surgery was 14.5±2.4 days. Aortic continuity was restored in situ with a Dacron prosthesis (79%), homograft (16%), or Gore-Tex graft (5%). Soft-tissue coverage of the prosthesis was performed in 8 patients. The mean follow-up time was 43.2±11.7 months. The early mortality rate was 10.5%, and the 5-year survival rate was 74.9%±11.5%. Conclusion This study showed acceptable early and midterm outcomes of open repair of mycotic aneurysms. We emphasize that aggressive intraoperative debridement with soft-tissue coverage results in a high rate of success in these high-risk patients.
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              Endovascular treatment of primary mycotic aortic aneurysms: a 7-year single-center experience

              Objective This study was performed to assess the efficacy and outcome of endovascular aneurysm repair (EVAR) for treatment of primary mycotic aortic aneurysms (PMAAs). Methods Fourteen consecutive patients who presented with PMAA from April 2010 to July 2017 were retrospectively reviewed. Preoperative, intraoperative, and postoperative clinical data were recorded, and late infection-related complications and long-term survival were assessed. Results The aneurysms were located in the abdominal aorta in 10 patients and in the left common iliac artery in 4 patients. Positive microbial cultures were found in 12 patients, including Salmonella species in 11 and Streptococcus in 1. The remaining two patients had negative culture results. Ten patients received preoperative antibiotics before elective EVAR for 7 ± 9 days after admission. Four patients who underwent emergent EVAR due to ruptured aneurysms were given their first dose of antibiotics before EVAR. Three patients underwent surgical drainage, and six underwent percutaneous drainage within 30 days after EVAR. No death occurred within 30 days of the initial procedure. The mean follow-up was 34.8 (range, 3–84 months). One patient underwent re-intervention to resolve obstruction of the iliac/femoral artery 5 months postoperatively. Relapse of infection occurred in six patients (42.8%) during follow-up; infection-related death occurred in three of these patients. The other patients recovered with either conversion to open radical surgery or medical therapy. The actuarial 7-year survival after EVAR was 75.7%. Conclusions EVAR and aggressive antibiotic therapy might be suitable for PMAAs. Favorable results may be typical for infection caused by Salmonella.
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                Author and article information

                Journal
                angiologia
                Angiología
                Angiología
                Arán Ediciones S.L. (Madrid, Madrid, Spain )
                0003-3170
                1695-2987
                August 2022
                : 74
                : 4
                : 201-202
                Affiliations
                [1] Bilbao orgnameHospital Universitario de Basurto orgdiv1Departamento de Medicina Interna y Radiología Spain
                Article
                S0003-31702022000400012 S0003-3170(22)07400400012
                10.20960/angiologia.00415
                3ef47534-d48f-4cd9-bb8d-2f11ac1f57cc

                This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.

                History
                : 28 March 2022
                : 10 March 2022
                Page count
                Figures: 0, Tables: 0, Equations: 0, References: 3, Pages: 2
                Product

                SciELO Spain

                Categories
                Imagen Clínica

                Tomografía computarizada,Aneurismas micóticos,Aneurisma aórtico,Radiología,Angiología,Computed tomography,Angiology,Radiology,Aortic aneurysm,Mycotic aneurysms

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