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Infected aneurysms caused by Yersinia are very uncommon and are principally due to Yersinia enterocolitica. We describe the first case of an infected aneurysm caused by Yersinia pseudotuberculosis in an elderly patient with a history of atherosclerotic cardiovascular disease.
We report a survivor of Campylobacter fetus septicemia from an infected abdominal aortic aneurysm who was successfully treated with an anatomic graft reconstruction and antibiotics. According to a survey of the English-language medical literature this was the fourth such patient successfully treated. C. fetus sepsis associated with an abdominal aortic aneurysm was first reported in 1971. The first patient to survive reconstruction of an aortic tube graft aneurysm infected with C. fetus was reported in 1983. Because the natural history of an aneurysm infected by C. fetus appears to be rapid progression to rupture, patients should be operated on promptly. All patients reported in the literature who were operated on before rupture survived. Survival was independent of the type of reconstruction. When the aneurysm ruptured all patients died. Whereas extraanatomic bypass is generally considered the procedure of choice for an infected abdominal aneurysm, the aneurysms of our patient and three other patients cited in the literature were reconstructed with anatomically placed prosthetic grafts. In the absence of other contraindications such as a grossly evident purulent infection, an abdominal aortic aneurysm infected by C. fetus may represent a subset of infected aneurysms that can be treated successfully with an anatomically placed prosthetic graft and antibiotics.
The infected aneurysm has been assumed to be a disease with a poor prognosis due to the occurrence of aneurysmal ruptures and sepsis, in contrast to the outcome of atherosclerotic aneurysms. In the present study, we conducted surgical treatment on five patients with infected aneurysms (infected abdominal aortic aneurysm in three cases and iliac artery aneurysm in two cases). In particular, two of the three patients suffering from infected abdominal aortic aneurysms underwent extra-anatomic bypass and the remaining one case underwent vascular graft replacement in situ. In the two patients who underwent an extra-anatomic bypass, an aneurysm was found at the site of aortic stump closure. In the patient who underwent in situ replacement, wrapping was carried out using the omentum after vascular graft replacement, and the postoperative course was uneventful. Accordingly, we consider that the optimum primary therapeutic intervention for infected aneurysms is in situ revascularization followed by wrapping with the omentum after removal of the aneurysm and debridement of the surrounding infected tissue to the maximum extent possible.
OBJECTIVE: The infrequency of infected aneurysms suggests that either infection of segments of the aortic wall is uncommon, or that infections do not always lead top infected aneurysm formation. The purpose of the study was to determine whether focal Staphylococcus aureus infection of aortic wall segments leads consistently to the development of infected aneurysms and to evaluate the segments in which infection did not lead to the infected aneurysm formation. METHODS: Twenty pigs were inoculated with 0.1 ml of a Staphylococcus aureus inoculum in three segments of the thoracic aorta wall (study group). In another 10 pigs, 0.1 ml of saline solution was injected in three segments of the thoracic aorta wall (control group). STUDY GROUP: histological abnormalities and bacterial culture of the inoculation sites were evaluated at 10 days (n = 5 pigs), 30 days (n = 5 pigs), and 90 days (n = 10 pigs). CONTROL GROUP: histological abnormalities were evaluated at 10 days (n = 5 pigs) and 90 days (n = 5 pigs). RESULTS STUDY GROUP: infected aneurysms developed in only two animals killed at 30 days. At 90 days, destruction of the elastic tissue, scar tissue and neointima formation were found in all the aortic segments studied. CONTROL GROUP: no significant changes were found in any of the segments evaluated. CONCLUSION: In our experimental model, acute local infection by S. aureus caused the development of infected aortic aneurysm in only 10% of the animals. In the remaining 90%, healing of the site of infection followed resolution of the infection.
Three cases of atherosclerotic abdominal aneurysms infected by Escherichia coli urinary tract sepsis are presented together with a review of four additional cases of E. coli-infected aneurysms. Pathophysiology and a current system of classification of aortic infection are discussed. Important clinical features of gram-negative aortic infection include a diagnostic triad and the tendency to early rupture. Resection of infected tissue and extra-anatomic bypass for revascularization are the cornerstones of operative management. The mortality rate of E. coli aortic infection is high, with one known survivor. Death is contributed to by the high frequency of preoperative rupture, the age of the patient, and the extent of atherosclerotic disease.
A 78-year-old-man was hospitalized for surgical treatment of a Yersinia enterocolitica serotype O:9 infected primary aortoabdominal aneurysm which ruptured soon after admission. Infection of aneurysm is an unusual manifestation of yersiniosis, especially in patients with no predisposing underlying condition. This case, and review of the literature, highlights that serotype O:9 has a predilection for vascular tissue. Cross reaction with Brucella spp. may be responsible for misdiagnosis of Y. enterocolitica O:9 infected aneurysms.
Fifty-three infected aneurysms of the groin in known drug abusers have been treated since 1970. There was a recent history of attempted intravenous drug injection into the femoral vein in 50 patients. Twenty-three patients underwent revascularization immediately preceding or following excision and ligation of the mycotic aneurysm. Five graft infections, resulting in one death and three amputations, occurred in this group. Three grafts became occluded, resulting in one additional instance of an amputation within six months of operation. Thirty patients underwent excision and ligation only. Five extremities were amputated in the immediate postoperative period because of irreversible ischemic changes. Six patients underwent delayed reconstruction five days to two months postoperatively because of rest pain or gangrene limited to the forefoot. No deaths and no graft infections occurred in this group. In infected aneurysms of the groin from drug addiction, we recommend initial excision with ligation and delayed selective revascularization, if indicated.
Infected aneurysms of the abdominal aorta are relatively uncommon, but potentially lethal if improperly managed. Two case reports emphasize the importance of the preoperative aortogram for accurate diagnosis. We stress the principles of total excision of infected tissue and revascularization in uninfected tissue planes. A useful vascular reconstructive technique consisting of unilateral axillofemoral bypass and an ilioiliac anastomosis was used in both patients.
Infected aneurysms of the aorta were first described as a result of septic emboli or contiguous spread from bacterial endocarditis and are usually caused by Staphylococcus or Salmonella species. We report a case of Nocardia-associated infected aneurysm of the native suprarenal aorta in an immunocompromised host. Surgical management consisted of placement of an interposition cryopreserved aortic homograft. Nocardia asteroides was identified on a microbiology specimen of the aorta and both microbiology and pathology specimens of the splenic tissue. To the best of our knowledge, this represents the first carefully documented, unique case of a Nocardia-infected aneurysm treated with homograft interposition. In addition, pathologic and microbiologic data are included from the postmortem examination 10 months later.
Infective intracranial aneurysms are relatively uncommon. They develop due to septic embolisation of the vasa vasorum or lumen of the artery, with resultant focal arteritis and necrosis, leading to aneurysm formation. They are an important cause for intracranial haemorrhage. Six cases of infective aneurysms are described. A focus of infection could be detected in all the patients. Surgery was done in three cases, out of which two patients made significant recovery, while one patient died in the immediate postoperative period. Out of the three cases, treated conservatively with antibiotic therapy, there was total resolution on follow up angiogram in two, while one patient was lost to follow up.
Treatment of infected aneurysms consists of operation, which depends on the location and pathologic type, and antibiotic therapy, before and at least six weeks following operation. The authors present a case of two consecutive aneurysms occurring in a patient with Salmonella infection. Full recovery was obtained after surgical excision of the aneurysms, prolonged antibiotic therapy, and cholecystectomy.
AIM: This study is an analysis of angiographic findings in 17 patients with infective aneurysms who presented with intracranial haemorrhage and reviews the management and outcome in the context of the existing literature. MATERIALS AND METHODS: A retrospective study of infective aneurysms in 17 patients was carried out. Cranial angiography was performed in all patients. The location, size and outline of aneurysms were analysed. Ten patients were managed conservatively and six patients underwent surgery for the ruptured infective aneurysms and were followed up for a period of 35.8 months and 23 months, respectively. RESULTS: Twenty-two aneurysms were identified (five unruptured) in 17 patients. Twenty aneurysms (90. 9%) were distal in location and two (9.1%) proximal. Sixty percent were in the posterior circulation with 55% in the posterior cerebral artery (PCA) territory, 27.3% in the middle cerebral artery (MCA) territory and 9.1% in the anterior cerebral artery (ACA) territory. Fourteen aneurysms were small (3-5 mm) and eight were medium sized (6-9 mm). 72.7% of aneurysms had irregular outline and 27.3% regular outline. Out of the 10 ruptured aneurysms managed conservatively, eight resolved. One patient died, presumably due to rebleed, and one had infarction due to parent vessel thrombosis. Six aneurysms were surgically managed with good results. Of the five unruptured aneurysms one was surgically managed and the remaining four conservatively managed patients did not bleed during follow-up. CONCLUSION: Patients with ruptured infective aneurysms fared well with medical management and the outcome in this series is better than that reported in literature. Patients on conservative management, however, need closer monitoring with angiographic follow-up. Active management is required with enlarging or persisting aneurysms.
Infected aneurysms of the thoracic aorta are rare in children, and many are not diagnosed until autopsy. We report the case of a 3-year-old girl in whom an infected aneurysm of the ascending aorta was successfully repaired by Dacron patch angioplasty under cardiopulmonary bypass.
Patients with infected aneurysms discharged from Department of Veterans Affairs hospitals during fiscal years 1986 to 1990 were identified using International Classification of Diseases codes to determine the proportion of patients infected with Salmonella. Twenty-three patients with infected aneurysms were identified. All patients were males; the median age was 63 years. A Gram-positive organism was recovered from 16 patients (70%), a Gram-negative organism from 6 patients (26%), and a fungus from 1 patient. Three patients, all with aneurysms of the abdominal aorta, were infected with Salmonella. Overall, the vessels most often involved included arteries of the extremities (10 patients) and the abdominal or thoracic aorta (9 patients). An increased incidence of nontyphoidal salmonellosis in the United States during the last few decades, along with an aging of the U.S. population, suggests that Salmonella can be expected to maintain a niche in the bacteriology of infected aneurysms.
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We report a patient who had an infected aneurysm of the lumbar artery caused by prolonged psoas abscess-forming spondylitis due to methicillin-resistant Staphylococcus aureus and who was treated successfully with transcatheter arterial embolization. This case suggests that an infected aneurysm can be treated successfully by transcatheter arterial embolization in emergent situations (active bleeding or septicemia) even if surgery is contraindicated.
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Infected abdominal aortic aneurysm is an uncommon but life-threatening disease, especially in case of salmonella infection. Early CT findings should be well known in order to allow immediate diagnosis and accurate management. The authors present an early CT finding of a salmonella infected aneurysm of abdominal aorta in an HIV-infected patient. This pattern consists in a slight-enhancing focal densification of periaortic soft-tissue, while aorta remains of normal size. Within two weeks, infection progressed to the constitution of an infected aneurysm. This CT finding seems to be initial to previously described signs.