Tuberculous aneurysm of the abdominal aorta: endovascular repair using stent grafts in two cases

Abstract

Tuberculous aneurysm of the aorta is exceedingly rare. To date, the standard therapy for mycotic aneurysm of the abdominal aorta has been surgery involving in-situ graft placement or extra-anatomic bypass surgery followed by effective anti-tuberculous medication. Only recently has the use of a stent graft in the treatment of tuberculous aortic aneurysm been described in the literature. We report two cases in which a tuberculous aneurysm of the abdominal aorta was successfully repaired using endovascular stent grafts. One case involved is a 42-year-old woman with a large suprarenal abdominal aortic aneurysm and a right psoas abscess, and the other, a 41-year-old man in whom an abdominal aortic aneurysm ruptured during surgical drainage of a psoas abscess.

Fig. 1

A 42-year-old woman with large aortic aneurysm and psoas abscess. A. Contrast-enhanced CT shows the characteristic appearance of mycotic aneurysm with thick inflammatory mantle and anterior displacement of abdominal aorta. B. Stent graft consisting of three segments of Z-stent covered with polytetrafluoroethylene, and fenestrated to secure flow along the celiac axis (arrow). C. One-year follow-up after stent graft. Abdominal CT shows successfully occluded tuberculous aneurysm and complete healing of psoas abscess.

Fig. 2

A 41-year-old man with rupture of aortic aneurysm during surgery for drainage of psoas abscess. A. Pre-operative enhanced CT shows psoas abscess with a small aneurysm of the aorta (arrow). B. Three months after stent graft deployment, the myocotic aneurysm was occluded and the psoas abscess had completely healed.