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At least 19 recordsLinked to original sources
PubMed1984

Bacteriologic and surgical determinants of survival in patients with mycotic aneurysms.

Mycotic aneurysms are a fulminant infectious process frequently resulting in rupture and death if not properly treated. A review of the University of California, Los Angeles, medical records identified 10 patients with extrathoracic, extracranial mycotic aneurysms. In addition, a search of the English literature revealed 178 patients with 243 mycotic aneurysms. These patients were reviewed to identify the aneurysm location, etiology, bacteriology, and modality of treatment in order to determine the relationship between these factors and the outcome. The femoral artery was the most common site (38%), followed by the abdominal aorta (31%). Arterial trauma was the primary etiology in 42% of mycotic aneurysms. In 25% no clear source of infection could be identified. Staphylococcus aureus was cultured from 28% of mycotic aneurysms, and Salmonella from 15%. A trend toward the involvement of more gram-negative aerobes and anaerobes is noted. Aortic aneurysms were repaired with in situ Dacron in 61% of patients with a 32% mortality rate and 16% reinfection rate. Simple ligation of femoral artery mycotic aneurysms resulted in a 34% incidence of ischemia necessitating amputation. Methods of treatment of superior mesenteric, carotid, iliac, and peripheral arteries are also analyzed. On the basis of these data, specific surgical procedures are recommended for the treatment of mycotic aneurysms.

Adolescent↗
PubMed1994

Successful surgical treatment of a coronary artery mycotic aneurysm.

Mycotic aneurysms of the coronary artery are rare. We report the case of a mycotic aneurysm of the left anterior descending artery. Surgical treatment consisted of simultaneous resection of the aneurysm and revascularization using a venous graft. Thirteen cases of mycotic aneurysms of the coronary arteries have been reported in the literature, and we review these cases.

Adult↗
PubMedDate not supplied

Mycotic aneurysm.

Mycotic aneurysms must be diagnosed rapidly because of the high mortality, associated with them. X-ray computed tomography (X-CT) is a noninvasive modality. Intravenous digital subtraction angiography (IVDSA) is also much less invasive and less dangerous than arteriography, especially in mycotic aneurysms, whose wall is thin. We describe two patients with mycotic aneurysms diagnosed by X-CT and IVDSA.

Aged↗
PubMed1983

Surgical considerations in aortitis. Part II: Mycotic aneurysms.

Mycotic aneurysms were first described as the result of nonsyphilitic bacterial infection of the arterial wall. They were often caused by septic emboli from bacterial endocarditis and were much more common prior to the era of antibiotics. Although the aorta is most often affected, such aneurysms may arise in any artery. Classified according to their etiology as primary, secondary, and cryptic mycotic aneurysms, it is imperative that immediate treatment be instituted once the diagnosis is confirmed by angiography. The patient should be placed on high doses of antibiotics appropriate for the offending pathogens. The goal of surgical treatment is the complete removal of the infected aneurysm and preservation of the distal circulation. Alternate methods of treating these lesions include the use of bypass grafts and interposition grafts. The virulence of the offending pathogen and the sensitivity to antibiotic therapy play a significant role in the success of these procedures.

Journal Article↗
PubMed1991

Surgical management of mycotic aneurysms.

Mycotic aneurysms not associated with trauma or atherosclerosis are uncommon. Their clinical presentation is insidious and lacks definite diagnostic criteria. This retrospective study of 14 patients treated over a period of 9 years confirms this, and shows that half are associated with a predisposing infected focus and that the main presenting clinical feature is that of a painful mass (64%) which is often mistaken for some other diagnosis. The main extracranial, extrathoracic site of predilection was the iliofemoral segment (65%). The main diagnostic investigation was angiography, which was also used to uncover silent aneurysms elsewhere in the arterial tree. Urgent surgical treatment is mandatory since complications may occur at any time and these may include life-threatening bleeding. Two of our patients experienced life-threatening gastro-intestinal bleeding while in hospital. The mainstay of treatment was surgical resection and reconstruction using an autologous vein or artery if possible. The more serious complication of graft failure was encountered mainly in patients who underwent prosthetic graft repair. It is in this group that 2 of the 3 early postoperative deaths occurred, from graft thrombosis and mesenteric infarction. Overall, surgical repair was attended with good outcome (77%).

Adolescent↗
PubMed1989

[Mycotic aneurysms].

Mycotic aneurysms are aneurysms infected by bacteria or fungi. These may be secondary to an endocarditis, or they may be primary, and then are developed from a septicemia or bacteremia. The diagnosis, often difficult, is sometime only made during complications, the most severe of which is rupture. This diagnosis must be aided by new imaging techniques such as ultrasonography, tomodensitometry, magnetic resonance imaging. The treatment is medical (antibiotics) and surgical.

Adult↗
PubMed1985

Treatment of mycotic aneurysms.

Mycotic intracranial aneurysms may be treated by antibiotic therapy alone. Careful evaluation of this mode of treatment has been hampered by inadequate angiographic and microbiological documentation. The present case details the successful conservative management of one of these lesions in a patient who had previously undergone craniotomy for a separate mycotic aneurysm.

Adult↗
PubMed2005

Role of delayed Tc-99m HMPAO labeled leukocyte scintigraphy in the diagnosis of coronary mycotic aneurysm.

Coronary mycotic aneurysms are rare with a poor prognosis. Atherosclerosis often predisposes to aneurysmal dilatation. In children, Kawasaki disease and in adults trauma, vasculitis, syphilis, dissection, and postcoronary angioplasty contribute to coronary mycotic aneurysms. Radiolabeled leukocytes have been used in the diagnosis of prosthetic valve endocarditis and vascular graft infections. Abnormal accumulation of radiolabeled leukocytes have also been reported in infra renal aortic aneurysms. We present a case of a coronary mycotic aneurysm where delayed Tc-99m HMPAO labeled leukocyte imaging played an important role leading to the diagnosis.

Adult↗
PubMed1997

[A case report of postcoarctation mycotic aneurysm after surgical treatment for cerebral arterial aneurysms].

Postcoarctation mycotic aneurysm of the aorta is very rare. We present a case of a 55-year-old man with postcoarctation mycotic aneurysm of the aorta infected with methicillin resistant staphylococcus aureus (MRSA) after surgical treatment for cerebral arterial aneurysms. The operation was performed after negative conversion of MRSA in blood culture using antibiotics. The mycotic false aneurysm was completely resected following institution of an extra-anatomical bypass from the ascending aorta to abdominal aorta above celiac artery.

Aneurysm, Infected↗
PubMed1994

[Esophageal perforation after replacement of descending thoracic aorta for rupture mycotic aneurysm].

Primary mycotic aneurysm of the thoracic aorta has rarely been reported. The patient was a 61-year-old male who had a ruptured mycotic aneurysm of the descending thoracic aorta without any evidence of infectious disorders in his history. The patient developed esophageal perforation after graft replacement of the descending thoracic aorta. After continuous irrigation of the left pleural cavity and the mediastinum for one month, the thoracic esophagus was resected and reconstructed. However, the patient died of DIC following uncontrolled sepsis on the 98th postoperative day. Pathogenesis of the esophageal perforation and operative procedures that might have been effective in saving the patient were discussed.

Aneurysm, Infected↗
PubMed2004

Recurrent Klebsiella pneumoniae mycotic aneurysm in a diabetic patient and emergence of an extended-spectrum beta-lactamase (CTX-M-24)-containing Klebsiella pneumoniae strain after prolonged treatment with first-generation cephalosporins for mycotic aneurysm.

A 68-year-old diabetic woman suffered from mycotic aneurysm due to Klebsiella pneumoniae over her abdominal aorta; she received surgical intervention, followed by treatment with first-generation cephalosporins for 6 months. She was hospitalized again 11 months later because of another episode of mycotic aneurysm caused by K. pneumoniae on her thoracic aorta. Fingerprinting generated by pulsed-field gel electrophoresis and infrequent-restriction-site polymerase indicated K. pneumoniae isolates of the identical clonal strain were responsible for these two mycotic-aneurysm episodes. Unfortunately, nosocomial pneumonia developed at the second hospitalization; blood and purposefully sampled feces specimen cultures both grew CTX-M-24-producing K. pneumoniae, which were of the same strain and genetically nonrelated to the K. pneumoniae strain causing mycotic aneurysms earlier. This is the first report on infection due to CTX-M-24-producing K. pneumoniae. It is unclear whether the prolonged use of first-generation cephalosporins in this case selected a strain of enteric organism possessing the ESBL in question, which was capable of passing this ESBL plasmid to the K. pneumoniae strain causing the nosocomial infection. This report suggests that further observation is needed before one can draw a conclusion on the possibility of the selection of ESBL enteric organism by extensive exposure to first-generation cephalosporins.

Aneurysm↗
PubMed1995

[Cervical epidural anesthesia for carotid mycotic aneurysms].

Extracranial mycotic aneurysms of the carotid are unusual. We present such an aneurysm of the right primary carotid caused by enteritis due to Salmonella in a 75-year-old patient at high risk for surgery (myocardial ischemia evolving over 3 months) and with coexisting stenosis of 75% of the left internal carotid. Endarterectomy of the left internal carotid, with shunting, was performed, after which the right primary carotid was tied during the same operation. Epidural anesthesia to C6-C7 was provided through a catheter supplemented with an intravenous propofol infusion. Neurological and hemodynamic variables monitored during surgery were stable. No neurological deficits or myocardial ischemic changes were recorded. Three months after discharge the patient was asymptomatic.

Aged↗
PubMed2002

[A ruptured distal aneurysm, thought to be a mycotic aneurysm, associated with acute subdural hematoma: case report and review of the literature].

A case is described of a ruptured intracranial mycotic aneurysm in the distal middle cerebral artery associated with an acute subdural hematoma. A 55-year-old woman, with a history of tuberculous meningitis at the age of 7, presented left hemiparesis. She was in a state of semi-coma. Computed tomography scan showed a right acute subdural hematoma. Magnetic resonance angiography revealed no cerebral aneurysm. Emergency external decompression was performed and a distal central artery aneurysm was found and was resected during the operation. Numerous areas of hemosiderin pigmentation were recognized around the aneurysm and in the subarachnoid space. Microscopic examination of the aneurysmal sections showed neither elastic lamina nor membranous structures and no infiltration of any inflammatory cells. We think this aneurysm is a pseudoaneurysm. The incidence of ruptured mycotic aneurysms presenting with acute subdural hematoma is extremely low. There have been only four previously reported cases as far as I can ascertain. This case and a review of the literature are discussed.

Aneurysm, Infected↗
PubMed1992

Implantation of antibiotic-releasing carriers and in situ reconstruction for treatment of mycotic aneurysm.

Four patients with mycotic aneurysm of the extracranial carotid artery, the innominate artery, the ascending aorta, and the infrarenal aorta were treated with local implantation of antibiotic-releasing carriers after resection of the aneurysm, excision of all infected tissue, and in situ reconstruction by prosthetic graft replacement in two patients and patch plasty in two patients. The patient with a mycotic aneurysm of the ascending aorta was operated on again 1 month after the first operation because of a second mycotic aneurysm located on the aortic arch. No early or late signs of recurrent infection were seen on clinical and laboratory postoperative follow-up done between 9 and 16 months or on duplex scan or computed tomography done at these times. Implantation of antibiotic-releasing carriers after débridement of all infected tissue and in situ reconstruction for treatment of mycotic aneurysm was performed successfully in four patients with this life-threatening condition.

Aged↗
PubMed1989

Synchronous mycotic aneurysms secondary to tuberculosis.

Mycotic aneurysm secondary to Mycobacterium tuberculosis is extremely unusual. We describe a 28-year-old female patient with tuberculosis who developed synchronous mycotic aneurysms of the abdominal aorta and the innominate artery. The pathogenesis, diagnosis, and treatment of tuberculous mycotic aneurysm is reviewed.

Adult↗