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Letters to the Editor

Reply to Ugurlucan and Alpagut

Endovascular management of a descending thoracic mycotic aneurysm: Mid term follow-up

Division of Cardiac Surgery, Bluhm Cardiovascular Institute, Northwestern Memorial Hospital, Chicago, IL, USA

Received 22 August 2007; accepted 24 August 2007.

^_* Corresponding author. Address: Department of Cardiovascular and Endovascular Surgery, Arizona Heart Hospital and Institute, 2632 N.20th Street, Phoenix, AZ 85006, USA. Tel.: +1 602 266 2200; fax: +1 602 604 5020. (Email: jkpodonu{at}azheart.com).

Key Words: Thoracic mycotic aneurysm • Endovascular stent repair • Antibiotics

I would like to thank Ugurlucan and Alpagut [1] for their valuable comments regarding the management of thoracic mycotic aneurysms using endovascular technology. Endoluminal stent grafting of the aorta has increasingly been applied to treat various aortic pathologies including mycotic aneurysms. Results of open surgical repair consisting of intensive antibiotic administration, extensive excision and debridement of the infected field associated with extra-anatomic or in situ prosthetic bypass grafting are associated with mortality rates ranging from 5% to 75% [2,3]. Endovascular approach to mycotic aneurysm avoids the extensive excision and debridement of the infected field. The potential benefit of the endovascular approach is thus compared to the obvious risk of recurrence of the infection. We have had experience with the management of two patients with suspected mycotic aneurysms. In both cases an identifiable organism was cultured from the blood stream. Antibiotics must be tailored to the offending organism and preferably blood cultures should be negative before planning to treat such patients with an endoluminal graft. Some authors have suggested presoaking the graft in an antibiotic solution before deploying an endoluminal graft to exclude a suspected mycotic aneurysm. An extended zone proximal and distal to the aortic wall abnormality should be chosen because of the likelihood of more extended arterial lesions. The duration of antibiotic coverage remains controversial. The duration of antibiotic therapy remains debatable as some authors have used a short course of antibiotics ranging from 6 weeks to 6 months with other authors using life-long antibiotics [4,5]. At our institution we are of the belief that antibiotic coverage should be tailored to the patient's general condition, blood culture results, sedimentation rate, presence or absence of fevers and leucocytosis. Although in our two patients who were treated with a stent graft for a mycotic aneurysm we had recommended life-long antibiotics, the patients stopped their antibiotics after 6 weeks. We continuously follow patients with mycotic aneurysms receiving an endoluminal graft clinically to detect any sign of reinfection and radiologically with serial CT scans to determine regression of the mycotic aneurysm with stabilization of the thoracic aorta.

In conclusion, life-long surveillance is necessary in patients with mycotic aneurysms treated with an endoluminal graft.

References

1. Ugurlucan M, Alpagut U. Endoluminal stenting of thoracic aorta mycotic aneurysms. Eur J Cardiothorac Surg 2007;32:945-946.[Free Full Text]
2. Hsu RB, Tsay YG, Wang SS, Chu SH. Surgical treatment for primary infected aneurysm of the descending thoracic aorta, abdominal aorta and iliac arteries. J Vasc Surg 2002;36:746-750.[Medline]
3. Cina CS, Arena GO, Fiture AO, Clase CM, Doobay B. Ruptured mycotic thoracoabdominal aortic aneurysms: a report of three cases and a systematic review. J Vasc Surg 2001;33:861-867.[CrossRef][Medline]
4. Stanley M, Semmens JB, Lawrence-Brown MM, Denton M, Grosser D. Endoluminal repair of mycotic aneurysms. J Endovasc Ther 2003;10:29-32.[CrossRef][Medline]
5. Ting AC, Cheng SW, Ho P, Poon JT. Endovascular repair for multiple Salmonella mycotic aneurysms of the thoracic aorta presenting with Cardiovocal syndrome. Eur J Cardiothorac Surg 2004;26:221-224.[Abstract/Free Full Text]

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 Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Jacques Kpodonu Permission Requests Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Kpodonu, J. Search for Related Content PubMed Articles by Kpodonu, J. Related Collections Great vessels