Infected Aneurysm Research Articles

Infectious Aneurysm Formation after Coronary Stent Implantation

The formation of coronary artery aneurysm (CAA) is one of the critical complications after percutaneous coronary intervention (PCI). The most common aetiologies and aggravating factors for aneurysmal dilatation are acquired, such as atherosclerosis, Kawasaki disease, Takayasu disease, connective tissue disease, trauma after percutaneous coronary intervention (PCI) and infections. Cardiac catheterization itself carries a negligible bacteremic risk. We present the case of a patient who had infective coronary artery aneurysms that developed after PCI. A 63 years old male who had ST-T MI 1 month back and underwent primary percutaneous coronary intervention with deployment of 1 Des stent in Mid left anterior polymer-based paclitaxel-eluting stent 63 years having primary PCI for LAD 1 month back in the left anterior descending artery and A large aneurysm developed MID DES. The patient had C/O high grade fever only since 3 weeks remained asymptomatic then had angina at rest for 4 days. An aneurysm was diagnosed at middle of DES on repeat coronary angiography. Intravascular ultrasound demonstrated a true aneurysm about 5.6 mm in diameter. We will review the literature and discuss the causes specially infectious aneurysm and treatment option of aneurysm with stent usually detected at the time of repeat angiography for recurrent symptoms or as apart of the routine angiographic follow up [1].

Contained rupture of an infected abdominal aneurysm eroding into the L4 vertebra in a patient after aorto-femoral reconstruction

Uvod: Chronicka ohranicena ruptura břisniho aneurysmatu (AAA) erodujici do obratlů je relativně neobvykla. Jednim z projevů kromě pulsujici břisni rezistence může být nespecificka bolest v dolni casti zad. Kazuistika: Sedmdesatiletý pacient, muž po pravem aortofemoralnim protetickem bypassu (RAFB) před jedenacti lety, byl předan do naseho centra s nespecifickou bolesti dolni casti zad, ktera trvala poslednich 12 hodin. Výpocetni tomograficka angiografie (CTA) odhalila praskle AAA 57 × 63 mm erodujici do obratle L4. U pacienta byla naplanovana chirurgicka intervence. Mikrobiologicke vysetřeni kultury z AAA nasledně prokazalo infekci Staphylococcus hominis. Po zakroku byla u pacienta zahajena třitýdenni antibioticka terapie linezolidem. Výsledky: V soucasne době mame třiměsicni sledovani u pacienta bez znamek infekce v proteticke nahradě infrarenalni aorty na zakladě ultrazvuku. Zavěr: Bolest dolni casti zad je casta lekařska diagnoza. Jejim důvodem vsak nemusi být vždy primarni onemocněni pateře. Chronicke praskle AAA s erozi vertebralnich obratlů je neobvyklým projevem praskleho AAA. © 2020, CKS.

Infected Coronary Artery Aneurysm - A Rare but Fatal Complication of Percutaneous Coronary Intervention.

Infected Coronary Artery Aneurysm - A Rare but Fatal Complication of Percutaneous Coronary Intervention.

Septic cavernous sinus thrombosis—Case series and review of the literature

Background and PurposeSeptic cavernous sinus thrombosis (CST) is a rare, life-threatening disease with infectious thrombosis causing associated complications resulting in high morbidity and mortality. We report a series of CST patients with assessment of arterial and intracranial complications. MethodsWe used the radiology database from a large, academic tertiary care center to collect all patients treated with CST between 2002 and 2019. Patient demographics, source of infection, treatment course and outcomes were evaluated. A review of the recent literature was also performed for similar reported complications from CST. Results14 patients with CST treated during this time period were assessed. Of the 14 patients, 1 patient died. 7 patients had unilateral narrowing of ICA while 3 patients had bilateral narrowing. The ICA narrowing was reversible in 10/12 patients and improvement but persistent narrowing in one patient. One patient had an infectious pseudo aneurysm that was treated by coiling. Extension of thrombosis to the transverse- sigmoid sinuses and internal jugular vein were seen in 3 patients. Three patients had subdural empyema which was treated surgically. ConclusionThe prognosis of CST has improved with advancement in treatment, but complications are not infrequent.

Acute convexity subarachnoid hemorrhage (cSAH) in infectious endocarditis (IE): imaging features and follow-up.

To assess: (1) the prevalence of convexity subarachnoid hemorrhage (cSAH) in infective endocarditis (IE); (2) its relationship with IE features; (3) the associated lesions; (4) whether cSAH is a predictor of future hemorrhage; (5) whether cSAH could cause cortical superficial siderosis (cSS). We retrospectively evaluated the MRI data in 240IE-patients: At baseline, the location of cSAH and associated lesions; at follow-up, the occurrence of new lesions and of cSS. Patients with and without cSAH were compared. There were 21 cSAH-IE patients without (Group 1a) and 10 with intracranial infectious aneurysms (IIAs) (Group 1b). cSAH was revealed by headache (16.1%), confusion (9.7%), acute meningeal syndrome (3.2%) and was incidental in 71%. In most cases, the cSAH was: in the frontal (61.3%) and the parietal lobe (16.1%), unifocal, and mainly localized within a single sulcus (80.7%), appearing as a thick intrasulcal dark line on T2* in 70% of IIA patients. Valvular vegetations (87.1%, p < 0.0001), vegetations length ≥ 15mm (58.1%, p < 0.0001) and mitral valve involvement (61.3%; p = 0.05) were significantly associated. There was no significant difference between the two groups in terms of pathogen distribution, valve characteristics and clinical expression. Associated lesions were: CMBs (77.4%), DWILs (51.6%), brain hemorrhages (16.1%) brain micro-abscesses (3.2%) meningitis (3.2%), visceral emboli (45.2%). At follow-up: no SAH recurrence or neurological event. cSS disappeared in 7/12 cases. cSAH in IE is mostly an incidental finding but may be the telltale sign of an IIA. cSAH is not a marker of poor prognosis in non-IIA patients.

降下性壊死性縦隔炎の治療中に感染性顔面動脈仮性動脈瘤破裂を合併した1例(A case of infected facial pseudoaneurysm rupture complicated with descending necrotizing mediastinitis)

要旨 症例は29歳の男性。当院受診10日程前より左下顎の腫脹と疼痛を認めていた。発熱と吐血により近医に搬送され，精査加療のため当院に紹介となった。CTにて左下顎から縦隔にかけて膿瘍形成，両側胸腔内にも被包化された胸水貯留を認めた。降下性壊死性縦隔炎・両側膿胸と診断し，頸部アプローチによる経皮的縦隔ドレナージ・両側胸腔ドレナージを行い，集学的治療を開始した。第9病日に縦隔のドレーン排液が血性となりショックとなったため造影CTを施行したところ，左顔面動脈仮性動脈瘤破裂による造影剤の血管外漏出像を認めた。感染性顔面動脈仮性動脈瘤破裂と診断し緊急血管造影・コイル塞栓術にて止血を行った。動脈瘤破裂の影響で縦隔の膿瘍腔内に血腫を形成しドレナージ不良となったため，第18病日に胸腔鏡補助下縦隔ドレナージ術を施行し第21病日から27病日にかけてウロキナーゼの胸腔内投与を行った。第30病日に感染源と思われる左下顎齲歯の抜歯を行った。徐々に全身状態は改善し，第59病日に紹介元の病院に転院となった。降下性壊死性縦隔炎の症例は感染性動脈瘤の合併の有無について評価を十分行うべきであり，治療においては全身管理に加えて感染源の口腔内環境の制御も重要であると考えられた。

Diagnostic Accuracy of PET/CT and Contrast Enhanced CT in Patients With Suspected Infected Aortic Aneurysms

Infected aortic aneurysms are highly lethal, and management is very demanding, requiring an early diagnosis. The aim of this study was to evaluate the diagnostic accuracy of positron emission tomography/computed tomography with 18F-fluorodeoxyglucose (PET/CT) and contrast enhanced CT (CE-CT) in patients with suspected infected aortic aneurysms. PET/CT was performed in patients with clinically suspected infected aortic aneurysms, and additional CE-CT was performed if feasible. Diagnostic accuracy was assessed by two independent readers using a four point grading score for both imaging modalities. Maximum standardised uptake values (SUVmax) were calculated for quantitative measurements of metabolic activity in PET/CT. The reference standard was a combination of clinical presentation, laboratory findings, and imaging. Ten patients were included prospectively in the study, 24 retrospectively; 16 patients (47%) prior to the start of antimicrobial treatment and all 34 patients prior to any vascular intervention. Thirteen of the 34 patients had an infected aortic aneurysm (38%). Proven infected aortic aneurysms were all metabolically active on PET/CT with a median SUVmax of 6.6 (interquartile range 4.7-21.8). Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy of PET/CT for the diagnosis of infected aortic aneurysm was 100%, 71%, 68%, 100%, and 82%, for reader 1 and 85%, 71%, 65%, 88%, and 77%, for reader 2. Respective values for CE-CT, performed in 20 patients (59%), were 63%, 75%, 63%, 75%, and 70%, for reader 1 and 88%, 50%, 54%, 86%, and 65%, for reader 2. The diagnostic accuracy of PET/CT in the detection of infected aortic aneurysms (n=13) is high, and higher than CE-CT. While PET/CT demonstrates an excellent sensitivity, its specificity is hampered because of false positive findings.

Vascular Injuries in Intravenous Drug Addicts—A Single-Center Experience

Infected false aneurysms (IFA) caused by intravenous drug abuse are uncommon but challenging lesions. The best approach for the surgical management of this condition is still unknown. The aim is to present a single-center 14-year experience in the IFA treatment in intravenous drug abusers, thus providing additional data regarding the treatment options and outcome in these patients. A retrospective analysis of 32 consecutive patients with vascular injuries secondary to intravenous drug abuse, during the period from January 2004 to April 2018, was performed. Data of interest were extracted from patients' medical history records, anesthesia charts, and database implemented in daily practice, or were obtained by personal contact. The diagnosis was set based on history, physical examination and/or color Doppler sonography, multidetector computed tomographic angiography, and digital subtraction angiography. The outcome included graft patency, limb amputation, and mortality. During study period, 32 heroin abusers, predominantly males (81%), were surgically treated due to vascular injuries, with mean age of 35.2 years. The vast majority of patients have had an injury of the lower extremity blood vessels (84.3%) and the common femoral artery was the most common site of injury (59.4%). Three-quarters of patients underwent resection of the false aneurysm and ligation of the artery without reconstruction of the blood vessel. In 7 cases (21.9%), arterial reconstruction was performed with overall failure rate of 42.86%. The overall mortality rate was 6.25% and the rate of extremity salvage was 96.7%. The best treatment option is yet to be found, but based on the results of the present study, ligation of affected artery without revascularization seems to be an efficient, safe, and optimal treatment method, with minor risk of the extremity loss.

Therapy Control in a Patient With an Inflammatory Abdominal Aneurysm

We present a case of inflammatory abdominal arterial aneurysms, which demonstrates the potential usefulness of PET/CT with F-FDG in long-term monitoring of this disease, but also demonstrates potential pitfalls in abdominal arterial aneurysm imaging with PET/CT. Imaging may be challenged as the initial presentation prior to therapy may mimic an infected aneurysm. Follow-up images may be mistaken for vascular graft infection or persistent disease.

Rapid formation and rupture of an infectious basilar artery aneurysm from meningitis following suprasellar region meningioma removal: a case report

BackgroundInfectious basilar artery (BA) aneurysm has been occasionally reported to be generated from meningitis following transcranial operation. However, infectious BA aneurysm formed by intracranial infection after endoscopic endonasal operation has never been reported.Case presentationA 53-year-old man who was diagnosed with suprasellar region meningioma received tumor removal via endoscopic endonasal approach. After operation he developed cerebrospinal fluid (CSF) leak and intracranial infection. The patient ultimately recovered from infection after anti-infective therapy, but a large fusiform BA aneurysm was still formed and ruptured in a short time. Interventional and surgical measures were impossible due to the complicated shape and location of aneurysm and state of his endangerment, therefore, conservative anti-infective therapy was adopted as the only feasible method. Unfortunately, the aneurysm did not disappear and the patient finally died from repeating subarachnoid hemorrhage (SAH).ConclusionThough extremely rare, it was emphasized that infectious aneurysm can be formed at any stage after transnasal surgery, even when the meningitis is cured. Because of the treatment difficulty and poor prognosis, it was recommended that thorough examination should be timely performed for suspicious patient to make correct diagnosis and avoid fatal SAH.

INFECTED ABDOMINAL AORTIC ANEURYSM: A RARE ENTITY

Infected aortic aneurysms are rare and present a high risk for rupture. Clinically, infected Abdominal Aortic Aneurysms (AAA) may present with diffuse abdominal pain or pain radiating to the back in a setting of bacteremia. Many of these patients may already have an infrarenal AAA that acts as a

Abstract TP450: Characteristics and Disability Outcomes of Left Ventricular-Assist Device Associated Cerebrovascular Events in Setting of Infectious Intracranial Aneurysms: A Retrospective Single Center Study

Introduction: Stroke and infection are among the more common complications of LVAD therapy related to higher rates of mortality. The characteristics and disability outcomes of LVAD-associated cerebrovascular events and infections, particularly in the setting of infectious intracranial aneurysms (IIA), have not been defined. Methods: A single-center retrospective review of patients having undergone LVAD implantation between 2011-2017 was conducted using institutional registries and screened for hemorrhagic and ischemic strokes. Patients with hemorrhagic stroke were assessed for concurrent bacteremia; neurovascular imaging was then used to isolate patients with associated IIA. Review of comorbidities, imaging characteristics, and management were performed to determine predictors of disability outcomes, as defined by 90-day modified Rankin scales (mRS). Results: Of 383 patients with HeartMate II LVAD implantation, 46 all-cause stroke events were identified across 38 (12%) patients. 31 ICH events were identified, with 22 complicated by bacteremia (evidenced by chronic driveline infection and/or positive blood cultures on admission). Of patients with ICH and bacteremia, Staphylococcus aureus (n=12, 54.5%) and Pseudomonas aeruginosa (n= 10, 45.5%) infection were the highest associated causal organisms; severe disability or death (90-day mRS &gt; 4) was seen in 16 (72.7%) patients. 7 (31.8 %) patients had confirmed findings of IIA on diagnostic cerebral angiogram, and were associated with distal MCA territory involvement (100%), concurrent Pseudomonas infection (83.3%), and INR &gt; 3.0 (66.7%). Despite endovascular intervention in patients with IIA, 4 patients failed management and were withdrawn from care. Conclusion: Our results indicate Pseudomonas aeruginosa and Staphylococcus aureus bacteremia are associated with greater incidence of hemorrhage and neurological disability. Further investigation is warranted to better define management of these patients. Future considerations may include pre-implantation cerebrovascular imaging to assess for vascular pathology as a screen for higher risk patients, as well as more aggressive antibiotic therapy at bacteremia onset.

The "connecting vessel" sign: an imaging biomarker to differentiate ruptured infected (mycotic) intracranial aneurysm mimicking the CTA spot sign.

Infected (mycotic) intracranial aneurysms (IIA) are a prevalent source of morbidity in patients with systemic infection. Unlike saccular aneurysms, ruptured IIA frequently presents with intracerebral hemorrhage (ICH), and the appearance of ruptured IIA on CTA overlaps with the CTA "Spot Sign" (SS), an imaging finding in non-infectious, spontaneous ICH. The purpose of this study was to investigate the imaging and clinical features which may differentiate these two entities on CTA for which treatment strategies differ substantially. In an IRB-approved, retrospective case series, we compared 14 patients with confirmed IIA and 14 patients with positive SS due to other non-infectious etiology (SS(+) ICH). Clinical history, laboratory studies, and CTA reports and images were reviewed to define imaging characteristics of IIA and SS(+) ICH, including the diagnostic criteria for SS used in clinical trials. A total of 7/14 patients (50.0%) diagnosed with IIA had ICH at presentation. Of these, 3/7 patients (42.9%) with ruptured IIA and ICH met diagnostic imaging criteria of SS. The remaining 4/7 patients did not meet criteria due to presence of a connecting vessel. Compared with SS(+) ICH of non-infectious etiology, patients with ruptured IIA were younger (40.7 vs. 66.4years) and had higher rates of IVDU and bacteremia (p < 0.01) and lower rates of hypertension (p < 0.01). Hematoma volume was similar in both groups, but lobar location was more frequent in ruptured IIA (p = 0.06). Mortality at 1year from diagnosis was equally high in both groups (42.9%). This study characterizes ruptured IIA as an imaging mimic of SS and provides a framework for differentiating these lesions, allowing prompt diagnosis and appropriate treatment.

Aortoenteric fistula after endovascular aortic repair of infected abdominal aortic aneurysm

Secondary aortoenteric fistula is a rare yet fatal condition that may occur as a complication after abdominal aortic aneurysm repair. Here, we report a case of a 66-year-old male with abdominal discomfort and intermittent fever at 5 years after endovascular aortic repair of an infected abdominal mycotic aneurysm. Surgical treatment with extra-anatomic bypass for lower body revascularization, followed by exploratory laparotomy with explantation of the infected graft and aortic tissue and repair of the duodenum were performed. The patient was rescued from the septic condition and discharged uneventfully 2 months postoperatively.

Successful Surgery for Coral Reef Aorta Owing to Takayasu’s Arteritis Complicated by Infected Aortic Aneurysms

A 61-year-old woman presented with coral reef aorta (CRA) owing to Takayasu’s arteritis (TA) complicating infective aortic aneurysms. Though antibiotic therapy was continued, infective aortic aneurysms were growing, so urgent surgical treatment was required. First, we performed thoracic endovascular aortic repair (TEVAR) using trans-subclavian access, followed by open repair. TEVAR access and landing zone are limited in CRA cases. Moreover, the risk of persistent infection may be important in the situation where sepsis is ongoing. Few reports describe CRA complicated by infected aortic aneurysms. We describe a method of surgical treatment for this condition.

A case of infected aortic aneurysm complicated by invasive pneumococcal disease observed its formation course on CT

A case of infected aortic aneurysm complicated by invasive pneumococcal disease observed its formation course on CT

P1713 A case of quadricuspid aortic valve complicated with infective endocarditis diagnosed by 3D transesophageal echocardiography

Abstract Background Quadricuspid aortic valve (QAV) is a rare congenital heart disease with an estimated incidence of 0.008% to 1.46%. The functional status of QAV is predominantly a pure aortic regurgitation. The extensive use of echocardiography has allowed an early and accurate diagnosis of this malformation. In many cases, the transthoracic echocardiography (TTE) is suitable for the diagnosis but, transesophageal echocardiography (TEE), especially 3-dimensional (3D) TEE, is a tool for the accurate definition of the valve anatomy. Clinical case A 60-year-old female underwent a head CT for intermittent headaches for one month ago. She was admitted to neurosurgery in our hospital diagnosed of subarachnoid hemorrhage. Four mm aneurysm was found on the periphery of the right middle cerebral artery on CT examination, and a cerebral aneurysm coil embolization was performed with a catheter in emergency. The possibility of infectious cerebral aneurysm was pointed out, and we examined in cardiovascular internal medicine. TTE revealed moderate aortic regurgitation. The ventricular septum exhibits sigmoid septum. A mobile mass was found near the left ventricular outflow tract in the sigmoid septum. TEE revealed a hypoplasia cusp (accessory cusp) is found between non coronary cusp and right coronary cusp. Aortic valve leaflets have become thickened and regurgitation from the central part of the cusps. 3DTEE was able to more accurately visualize that only the accessory cusp was hypoplastic, and the size of the other three leaflets appears almost the same. Similarly, vegetation on the left ventricular outflow tract were clearly revealed by 3DTEE. Based on the above, it was diagnosed that quadricuspid aortic valve complicated with infective endocarditis (IE) with aortic valve regurgitation. After treatment with antibiotics according to IE, surgical treatment was scheduled. Discussion QAV is a rare congenital heart disease, and TTE is an important imaging tool for accurate diagnosis. Furthermore, TEE, especially 3DTEE, was a more appropriate diagnostic method in QAV and IE. Abstract P1713 Figure. 3DTEE

Anatomical Reconstruction Using Femoral Vein for the Treatment of an Infected Abdominal Aortic Aneurysm

Anatomical Reconstruction Using Femoral Vein for the Treatment of an Infected Abdominal Aortic Aneurysm

A Case of Infected Aortic Aneurysm Caused by Bacteremia due to Perforation of Ascending Colon Cancer

A Case of Infected Aortic Aneurysm Caused by Bacteremia due to Perforation of Ascending Colon Cancer

An Infected Popliteal Aneurysm Simultaneously Treated with Resection and Revascularization.

Infected popliteal aneurysm is a high-risk condition that may present as an emergency requiring an urgent attention with acute rupture and sepsis. The management of acute ischemia in the presence of local and systemic sepsis is challenging, and infection control and perioperative management during surgery are important. Here we report successful case of treating a patient with an infected popliteal aneurysm. The infection seemed to arise from the soft tissue surrounding the aneurysm, following cellulitis. Our report also includes a review of the related literature and suggests that devising methods for infection control is critical in achieving acceptable outcomes in such cases.