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Letters to the Editor

Endoluminal stenting of thoracic aorta mycotic aneurysms

Istanbul University, Istanbul Medical Faculty, Department of Cardiovascular Surgery, Istanbul, Turkey

Received 8 July 2007; accepted 24 August 2007.

^_* Corresponding author. Address: Bozkurt Caddesi, No.: 110-112, Benli Apt., Daire: 6, 80250 Kurtulus/Istanbul, Turkey. Tel.: +90 535 431 67 86; fax: +90 212 534 22 32. (Email: muratugurlucan{at}yahoo.com).

Key Words: Thoracic aorta • Mycotic aneurysm • Endovascular stent graft

We read with interest the paper by Kpodonu et al. in which they present their single case experience of 33-month follow up of a patient who had undergone endovascular stent graft management of a descending thoracic mycotic aneurysm [1]. We would like to congratulate the authors for their successful result in this controversial topic of vascular surgery despite their single case.

Endoluminal stent grafting is frequently applied to the aneurysms at critical segments of the aorta, such as thoracic and arch levels and can even be used for the treatment of mycotic aneurysms, with the increasing experience and refinements in the graft technology [2]. However, graft infection still accounts for one of the major risks in the follow up, although the procedure promises very good early results [1–4].

At our institution, two patients who were considered unsuitable for surgical treatment due to multiple comorbidity factors, had undergone endoluminal stent graft treatment of mycotic saccular aneurysms at the aortic arch. Unfortunately, one of the patients died 1 week postoperatively due to intracerebral bleeding. On the other hand, the second patient who was on chemotherapy for acute lymphoblastic leukemia, additionally had ankylosing spondilitis and chronic hepatitis B infection. He had also been uneventful in the early postoperative period [2] as well as for a postoperative period of 18 months until he presented with rupture of the descending aorta from the region at the end of the stent graft (Suppl. 1). He had undergone another successful stent graft implantation for the treatment of the aortic rupture (Suppl. 2) and was discharged to the hematology clinic with a life-long antibiotic regimen recommendation with co-trimoxazole. He had been followed asymptomatic for another 1-year period but died due to complications of acute lymphoblastic leukemia [4]. Parkinson et al. [3] in their recent paper presented a similar case with peripheral seeding of mycotic aneurysm from an infected aortic stent graft. Their patient had been asymptomatic for 3.5 years following initial treatment [3].

In conclusion, close monitoring of the patients who were treated for mycotic aneurysms with endoluminal measures is mandatory because they may frequently present with future aneurysms and ruptures at various segments of arterial tree. Additionally, since prophylactic life-long antibiotic treatment seems to be protective to a certain degree against future complications of mycotic aneurysms, in order to reach a consensus about postoperative treatment strategy it would be helpful to determine the best antibiotics if every author could present their experiences and recommendations about prescribed antibiotics for such cases.

References

1. Kpodonu J, Williams JP, Ramaiah VG, Diethrich EB. Endovascular management of a descending thoracic mycotic aneurysm: mid-term follow-up. Eur J Cardiothorac Surg 2007;32(1):178-179.[Abstract/Free Full Text]
2. Alpagut U, Ugurlucan M, Kafali E, Surmen B, Sayin OA, Guven K, Dayioglu E, Rozanes I, Onursal E. Endoluminal stenting of mycotic saccular aneurysm at the aortic arch. Tex Heart Inst J 2006;33(3):371-375.[Medline]
3. Parkinson TJ, Rosales C, Wyatt MG. Peripheral seeding of mycotic aneurysms from an infected aortic stent graft. Eur J Vasc Endovasc Surg 2007;33(6):684-686.[CrossRef][Medline]
4. Alpagut U, Ugurlucan M, Guven K, Poyanli A, Acunas B, Tireli E, Rozanes I, Dayioglu E. Torasik aort patolojilerinde endovasküler stent greft tecrübelerimiz. Turkish J Vasc Surg 2007;16(Suppl. 1):53.

This article has been cited by other articles:

				D. Erer, E. Iriz, G. L. Oktar, and V. Y. Imren Etiology of saccular aortic aneurysms Interactive CardioVascular and Thoracic Surgery, June 1, 2008; 7(3): 509 - 509. [Full Text] [PDF]

				D. Erer, M. Banach, and M. Ugurlucan Endovascular treatment of mycotic aortic aneurysms. J. Thorac. Cardiovasc. Surg., June 1, 2008; 135(6): 1404 - 1404. [Full Text] [PDF]

				J. Kpodonu Reply to Ugurlucan and Alpagut * Endovascular management of a descending thoracic mycotic aneurysm: Mid term follow-up Eur. J. Cardiothorac. Surg., December 1, 2007; 32(6): 946 - 947. [Full Text] [PDF]

This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Ufuk Alpagut Permission Requests Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Ugurlucan, M. Articles by Alpagut, U. Search for Related Content PubMed PubMed Citation Articles by Ugurlucan, M. Articles by Alpagut, U. Related Collections Great vessels