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      Off-the-Shelf, Hybrid, Innominate Chimney Thoracic Endovascular Aneurysm Repair for Treatment of Mycotic Thoracic Aortic Aneurysm: A Case Report

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          Abstract

          Mycotic thoracic aortic aneurysm (MTAA) is a disease that is difficult to treat and often lethal. Open repair has high morbidity and mortality risks; additionally, thoracic endovascular aneurysm repair (TEVAR) often requires innovative techniques. We report the use of an innominate artery chimney endovascular aneurysm repair (ChEVAR) with carotid-carotid and carotid-left subclavian artery bypass for a time-sensitive Salmonella-related MTAA. A symptomatic type 1a endoleak was discovered and promptly and successfully treated. This report shows that the use of innominate artery ChEVAR to treat MTAA is feasible and safe, although the procedure is rarely performed, even in large series. We hypothesize that prophylactic gutter embolization is a feasible option in view of the high endoleak risks in such cases, although further evidence is required to support this.

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          Endovascular treatment of mycotic aortic aneurysms: a European multicenter study.

          Karl Sörelius, Kevin Mani, Martin Bjorck … (2014)
          Mycotic aortic aneurysm (MAA) is a rare and life-threatening disease. The aim of this European multicenter collaboration was to study the durability of endovascular aortic repair (EVAR) of MAA, by assessing late infection-related complications and long-term survival.
          Article 0 comments Cited 73 times – based on 0 reviews     Review now
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            Infected aortic aneurysms: clinical outcome and risk factor analysis.

            Ron-Bin Hsu, Shu-hui Chu, K. Chen … (2004)
            Infected aortic aneurysms are difficult to treat, and are associated with significant mortality. Hospital survival is poor in patients with severe aortic infection, Salmonella species infection, Staphylococcus aureus infection, aneurysm rupture, and suprarenal aneurysm location. We reviewed the clinical outcome in 46 patients with primary infected aortic aneurysms and identified clinical variables associated with prognosis. Data were collected by means of retrospective chart review. Univariate and multivariate logistic regression models were used for risk factor analysis. Between August 1995 and March 2003, 48 patients with primary infected aortic aneurysms were treated at our hospitals. Two patients with negative culture results were excluded. Of the remaining 46 patients, 35 patients had aortic aneurysms infected with Salmonella species and 11 patients had aortic aneurysms infected with microorganisms other than Salmonella species. There were 20 suprarenal infections and 26 infrarenal infections. Surgical debridement and in situ graft replacement were performed in 35 patients, with an early mortality rate of 11%. The incidence of late prosthetic graft infection was 10%. The 90-day mortality rate in patients operated on was 0% for elective operation and 36% for nonelective operation (P =.006, Fisher exact test). Independent predictors of aneurysm-related death were advanced age, non-Salmonella infection, and no operation. With timely surgical intervention and prolonged antibiotic treatment, in situ graft replacement provides an excellent outcome in patients with primary infected aortic aneurysms and elective operation. Mortality is still high in patients undergoing urgent operation. Advanced age, non-Salmonella infection, and no operation are major determinants of mortality.
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              Infectious thoracic aortitis: a literature review.

              R.J. Lopes, J Almeida, P.J. Dias … (2009)
              Infectious thoracic aortitis (IA) remains a rare disease, especially after the appearance of antibiotics. However, if left untreated it is always lethal. It usually affects patients with atherosclerotic aortic disease and/or infective endocarditis. Mycotic aneurysm is the most common form of presentation, although a few reports of nonaneurysmal infectious thoracic aortitis have also been described. Various microorganisms have been associated with infectious thoracic aortitis, most commonly Staphylococcal, Enterococcus, Streptococcus, and Salmonella species. It is extremely important to establish an early diagnosis of IA, because this condition is potentially life-threatening. However, diagnosis is frequently delayed since clinical manifestations are usually nonspecific. Antibiotherapy in combination with complete surgical excision of the infected aorta is the best choice of treatment. Copyright 2009 Wiley Periodicals, Inc.
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                Author and article information

                Journal
                Journal ID (nlm-ta): Vasc Specialist Int
                Journal ID (iso-abbrev): Vasc Specialist Int
                Title: Vascular Specialist International
                Publisher: The Korean Society for Vascular Surgery
                ISSN (Print): 2288-7970
                ISSN (Electronic): 2288-7989
                Publication date Collection: 2024
                Publication date (Electronic): 24 April 2024
                Publication date PMC-release: 24 April 2024
                Volume: 40
                Electronic Location Identifier: 11
                Affiliations
                [1 ]Department of General Surgery, Singapore General Hospital, Singapore
                [2 ]Department of Vascular Surgery, Singapore General Hospital, Singapore
                Author notes
                Corresponding author: Nick Ng Zhi Peng, Department of Vascular Surgery, Singapore General Hospital, Outram Road Singapore 169608, Singapore, Tel: 65-62223322, Fax: 65-62249221, E-mail: nick.ng.z.p@ 123456singhealth.com.sg
                Author information
                https://orcid.org/0000-0002-9889-0608
                https://orcid.org/0000-0001-6730-3637
                https://orcid.org/0000-0002-7892-8568
                Article
                Publisher ID: vsi-40-11
                DOI: 10.5758/vsi.230126
                PMC ID: 11056280
                PubMed ID: 38679430
                SO-VID: c9cbae53-925a-4c5c-83ee-51451fb8f219
                Copyright © Copyright © 2024, The Korean Society for Vascular Surgery
                License:

                This is an open-access article distributed under the terms of the Creative Commons Attribution Non-Commercial License ( http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                Date received : 12 December 2023
                Date revision received : 5 February 2024
                Date accepted : 17 February 2024
                Funding
                FUNDING None.
                Categories
                Subject: Case Report

                Keywords: mycotic aneurysm,thoracic aortic aneurysm,innominate artery,endovascular aneurysm repair,endoleak
                Data availability:
                Keywords: mycotic aneurysm, thoracic aortic aneurysm, innominate artery, endovascular aneurysm repair, endoleak

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