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. 2022 Jul 29:21:e20210206.
doi: 10.1590/1677-5449.202102061. eCollection 2022.

Primary infectious aortic aneurysm: a case series and review of the literature

Fernanda Beatriz Araújo de Albuquerque  1 , Matheus Oliveira Feijó  1 , Jacob Hindrik Antunes Smit  2 , Ricardo Bernardo da Silva  3 , Adenauer Marinho de Oliveira Góes  1   2
Affiliations

Primary infectious aortic aneurysm: a case series and review of the literature

Fernanda Beatriz Araújo de Albuquerque et al. J Vasc Bras. .

Abstract
in English, Portuguese

Infectious aneurysms, formerly known as mycotic aneurysms, are rare, most often involve the aorta in young patients, and have a greater tendency to rupture than aneurysms of other etiologies. The most characteristic shape is saccular and the most common etiologic agents are Staphylococcus sp. and Salmonella sp. There is scant and imprecise information in the literature about correct nomenclature, diagnosis, and treatment. The authors present three cases in which diagnostic and therapeutic procedures were documented. In addition to reporting this case series, the authors also present a review of the subject, outlining pertinent diagnostic and therapeutic strategies.

Resumo: Aneurismas infecciosos, anteriormente chamados de aneurismas micóticos, são raros; acometem com maior frequência a aorta de pacientes jovens e apresentam maior tendência à rotura do que aneurismas de outras etiologias. O formato sacular é o mais característico, e os agentes etiológicos mais comuns são Staphylococcus sp e Salmonella sp. A literatura fornece informações limitadas e imprecisas sobre a correta nomenclatura, diagnóstico e tratamento da doença. Os autores reuniram três casos cujos procedimentos diagnósticos e terapêuticos foram documentados. Além de relatar essa série de casos, realiza-se uma revisão sobre o tema, a fim de estabelecer estratégias diagnósticas e terapêuticas pertinentes.

Keywords: abdominal aortic aneurysm; aortic aneurysm; infectious aneurysm; ruptured aortic aneurysm.

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Conflict of interest statement

Conflicts of interest: No conflicts of interest declared concerning the publication of this article.

Figures

Figure 1
Figure 1. Computed tomography with intravenous contrast. (A) Axial slice; A: aorta; the asterisks mark an image compatible with periaortic collection/mass. (B) Reconstruction with the maximum intensity projection (MIP) technique. Observe the irregular outlines not just of the aneurysm, but also of the aortic segments proximal (black arrow) and distal (white arrows) of the aneurysm.
Figure 2
Figure 2. Intraoperative images. (A) Temporary hemostasis with endoluminal inflation of Foley catheters in the iliac arteries; (B) Vascularized pedicle of the great omentum; (C) Pedicle of the great omentum in position to be wrapped around the tubular Dacron graft.
Figure 3
Figure 3. Diagrams illustrating the tubular Dacron graft. (A) Omentum, right gastroepiploic artery (thin arrow) and left gastroepiploic artery (thick arrow); (B) Abdominal aorta after implantation of the Dacron graft. C) Omentum wrapped around the abdominal aortic graft.
Figure 4
Figure 4. Intraoperative images. (A) Large aneurysm of the infrarenal aorta. (B) Tubular Dacron graft. The arrow indicates where the posterior wall of the aorta was resected. The proximal anastomosis is already concluded.
Figure 5
Figure 5. Computed tomography with intravenous contrast, axial slice. (A) Aorta; the asterisks mark an image compatible with periaortic collection/mass.
Figure 6
Figure 6. Intraoperative images. Aortoiliac graft with bifurcated silver-impregnated Dacron prosthesis.
Figura 1
Figura 1. Tomografia computadorizada com contraste endovenoso. (A) Corte axial; A: aorta; os asteriscos correspondem a imagem compatível com coleção/massa periaórtica; (B) Reconstrução com técnica maximum intensity projection (MIP). Observar as irregularidades de contorno não apenas do aneurisma mas também dos segmentos aórticos proximais (seta preta) e distais (setas brancas) ao aneurisma.
Figura 2
Figura 2. Intraoperatório. (A) Hemostasia temporária com insuflação endoluminal de sondas de Foley nas artérias ilíacas; (B) Pedículo vascularizado do grande omento; (C) Pedículo do grande omento já posicionado para envolver o enxerto tubular de Dácron.
Figura 3
Figura 3. Representação de enxerto tubular de Dácron. (A) Omento, artéria gastromental direita (seta fina) e artéria gastromental esquerda (seta grossa); (B) Aorta abdominal após enxerto de Dácron; (C) Omento envolvendo a prótese na aorta abdominal.
Figura 4
Figura 4. Intraoperatório. (A) Volumoso aneurisma de aorta infrarrenal; (B) Enxerto tubular de Dácron. A seta aponta a área onde a parede posterior da aorta foi ressecada, anastomose proximal já concluída.
Figura 5
Figura 5. Tomografia computadorizada com contraste endovenoso, corte axial. (A) Aorta; os asteriscos correspondem a imagem compatível com coleção/massa periaórtica.
Figura 6
Figura 6. Intraoperatório. Enxerto aorto-ilíaco com prótese bifurcada de Dácron impregnada com prata.
See this image and copyright information in PMC

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