Homemade pericardial bifurcated graft for Q fever-infected abdominal aortic aneurysm open repair: a case report

Abstract

Q fever is a zoonotic infection caused by Coxiella burnetii. In rare cases, it can lead to vascular complications, including infected aneurysms. Successful treatment involves surgery and antibiotics, but there is no established consensus or clear recommendation for the choice of material graft. We report a case of abdominal aortic aneurysm infected by C. burnetii treated by open surgery with complete resection of the aneurysm and homemade bovine pericardial bifurcated graft reconstruction and long-term antibiotherapy using doxycycline. One year postoperatively, the patient had no sign of persistent infection or vascular complication. Moreover, C. burnetii immunoglobulins titers decreased 6 months postoperatively.

Keywords: Coxiella burnetii; Q fever; abdominal aortic aneurysm; inflammatory aortic disease; vascular surgery.

Figure 1

Preoperative imagery of infrarenal aortic aneurysm. (A) Three-dimensional computed tomography aortic aneurysm reconstruction with the TeraRecon Aquarius workstation preoperatively. (B) Preoperative computer tomography angiography of the infected abdominal aortic aneurysm with anterior aortic wall thickening and enhancement (white arrow). (C) Preoperative 18FDG-PET/CT revealing a significant uptake of anterior aneurysm wall (purple circle). bw, body weight.

Figure 2

Surgical open repair treatment. (A) View of the complete removal of the affected aortic aneurysm segment along with the surrounding tissue. (B) Intraoperative view of aortic reconstruction using a self-made bifurcated graft with a bovine pericardial patch.

Figure 3

Historical characteristics of the abdominal inflammatory aneurysm. (A) Severely altered aneurysmal wall with complex atherosclerotic plaques, thickened intima and surface thrombus (*), fragmented medial layer, and dense connective tissue in the adventitial layer inflammatory lesions next to atherosclerotic lesions but also far away, indicated with black arrows (Hematoxyline-Eosine-Safran, original magnification ×20). (B) Severely altered aneurysmal wall with disrupted architecture with loss of elastin fibers in the medial layer (‣) (Weigert, original magnification ×20). (C) Aortitis with abundant inflammatory infiltrate, especially in the adventitial layer, composed of lymphocytes and plasma cells (Hematoxyline-Eosine-Safran, original magnification ×20). (D) Zoomed-in section demonstrated the lymphoplasmacytic pattern of the inflammatory infiltrate (Hematoxyline-Eosine-Safran, original magnification ×400). (E) Zoomed-in section shows strong membranous and cytoplasmic straining of lymphocytes of anti-CD3 antibody (Immuno Histo Chemistry, original magnification ×400).