Primary infectious aortic aneurysm: a case series and review of the literature

Infectious aneurysms, formerly known as mycotic aneurysms, are rare, most often involve the aorta in young patients, and have a greater tendency to rupture than aneurysms of other etiologies. The most characteristic shape is saccular and the most common etiologic agents are Staphylococcus sp. and Salmonella sp. There is scant and imprecise information in the literature about correct nomenclature, diagnosis, and treatment. The authors present three cases in which diagnostic and therapeutic procedures were documented. In addition to reporting this case series, the authors also present a review of the subject, outlining pertinent diagnostic and therapeutic strategies.

Keywords:
infectious aneurysm; aortic aneurysm; abdominal aortic aneurysm; ruptured aortic aneurysm

Authorship

Fernanda Beatriz Araújo de Albuquerque

Universidade Federal do Pará – UFPA, Belém, PA, BrasilUniversidade Federal do ParáBrasilBelém, PA, BrasilUniversidade Federal do Pará – UFPA, Belém, PA, Brasil

http://orcid.org/0000-0002-6723-144X

Matheus Oliveira Feijó

Universidade Federal do Pará – UFPA, Belém, PA, BrasilUniversidade Federal do ParáBrasilBelém, PA, BrasilUniversidade Federal do Pará – UFPA, Belém, PA, Brasil

http://orcid.org/0000-0002-2610-4751

Jacob Hindrik Antunes Smit

Centro Universitário do Estado do Pará – CESUPA, Belém, PA, BrasilCentro Universitário do Estado do ParáBrasilBelém, PA, BrasilCentro Universitário do Estado do Pará – CESUPA, Belém, PA, Brasil

http://orcid.org/0000-0001-9499-5210

Ricardo Bernardo da Silva

Santa Casa de Londrina, Londrina, PR, BrasilSanta Casa de LondrinaBrasilLondrina, PR, BrasilSanta Casa de Londrina, Londrina, PR, Brasil

http://orcid.org/0000-0002-7260-5522

Adenauer Marinho de Oliveira Góes Junior

Universidade Federal do Pará – UFPA, Belém, PA, BrasilUniversidade Federal do ParáBrasilBelém, PA, BrasilUniversidade Federal do Pará – UFPA, Belém, PA, Brasil

http://orcid.org/0000-0001-9345-9539

Conflicts of interest: No conflicts of interest declared concerning the publication of this article.

Correspondence Adenauer Marinho de Oliveira Góes Junior R. Domingos Marreiros, 307, apartamento 802 CEP 66055-210 - Belém (PA), Brasil Tel.: +55 (91) 98127-9656 E-mail: adenauerjunior@gmail.com

Author information FBAA and MOF - Medical students, Universidade Federal do Pará (UFPA). JHAS - MD, Medicina, Faculdade de Medicina, Centro Universitário do Estado do Pará (CESUPA). RBS - Full member, SBACV; Assistant professor, Pontifícia Universidade Católica do Paraná (PUCPR); Chief of Serviço de Cirurgia Vascular, Santa Casa de Londrina. AMOGJ - Full member, SBACV; Adjunct professor, Faculdade de Medicina, Universidade Federal do Pará (UFPA) and Centro Universitário do Estado do Pará (CESUPA).

Author contributions Conception and design: FBAA, RBS, MOF and AMOGJ Analysis and interpretation: FBAA, MOF and AMOGJ Data collection: AMOGJ and RBS Writing the article: FBAA, MOF and JHAS Critical revision of the article: AMOGJ, RBS and JHAS Final approval of the article*: AMOGJ and RBS Statistical analysis: N/A. Overall responsibility: AMOGJ

*All authors have read and approved of the final version of the article submitted to J Vasc Bras.

SCIMAGO INSTITUTIONS RANKINGS

Universidade Federal do Pará – UFPA, Belém, PA, BrasilUniversidade Federal do ParáBrasilBelém, PA, BrasilUniversidade Federal do Pará – UFPA, Belém, PA, Brasil

Santa Casa de Londrina, Londrina, PR, BrasilSanta Casa de LondrinaBrasilLondrina, PR, BrasilSanta Casa de Londrina, Londrina, PR, Brasil

Figures | Tables

Figures (6)
Tables (1)

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Figure 1
Computed tomography with intravenous contrast. (A) Axial slice; A: aorta; the asterisks mark an image compatible with periaortic collection/mass. (B) Reconstruction with the maximum intensity projection (MIP) technique. Observe the irregular outlines not just of the aneurysm, but also of the aortic segments proximal (black arrow) and distal (white arrows) of the aneurysm.

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Figure 2
Intraoperative images. (A) Temporary hemostasis with endoluminal inflation of Foley catheters in the iliac arteries; (B) Vascularized pedicle of the great omentum; (C) Pedicle of the great omentum in position to be wrapped around the tubular Dacron graft.

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Figure 3
Diagrams illustrating the tubular Dacron graft. (A) Omentum, right gastroepiploic artery (thin arrow) and left gastroepiploic artery (thick arrow); (B) Abdominal aorta after implantation of the Dacron graft. C) Omentum wrapped around the abdominal aortic graft.

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Figure 4
Intraoperative images. (A) Large aneurysm of the infrarenal aorta. (B) Tubular Dacron graft. The arrow indicates where the posterior wall of the aorta was resected. The proximal anastomosis is already concluded.

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Figure 5
Computed tomography with intravenous contrast, axial slice. (A) Aorta; the asterisks mark an image compatible with periaortic collection/mass.

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Figure 6
Intraoperative images. Aortoiliac graft with bifurcated silver-impregnated Dacron prosthesis.

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Table 1
Criteria suggestive of infectious aneurysm etiology.

Figure 1 Computed tomography with intravenous contrast. (A) Axial slice; A: aorta; the asterisks mark an image compatible with periaortic collection/mass. (B) Reconstruction with the maximum intensity projection (MIP) technique. Observe the irregular outlines not just of the aneurysm, but also of the aortic segments proximal (black arrow) and distal (white arrows) of the aneurysm.

Figure 2 Intraoperative images. (A) Temporary hemostasis with endoluminal inflation of Foley catheters in the iliac arteries; (B) Vascularized pedicle of the great omentum; (C) Pedicle of the great omentum in position to be wrapped around the tubular Dacron graft.

Figure 3 Diagrams illustrating the tubular Dacron graft. (A) Omentum, right gastroepiploic artery (thin arrow) and left gastroepiploic artery (thick arrow); (B) Abdominal aorta after implantation of the Dacron graft. C) Omentum wrapped around the abdominal aortic graft.

Figure 4 Intraoperative images. (A) Large aneurysm of the infrarenal aorta. (B) Tubular Dacron graft. The arrow indicates where the posterior wall of the aorta was resected. The proximal anastomosis is already concluded.

Figure 5 Computed tomography with intravenous contrast, axial slice. (A) Aorta; the asterisks mark an image compatible with periaortic collection/mass.

Figure 6 Intraoperative images. Aortoiliac graft with bifurcated silver-impregnated Dacron prosthesis.

Table 1 Criteria suggestive of infectious aneurysm etiology.

Clinical presentation	Abdominal/lumbar pains
	Fever
	Sepsis/shock
Laboratory	Elevated C-reactive protein
	Elevated leukocytes
	Positive blood/aortic tissue culture
Computed tomography	Saccular/multilobed outlines
	Periaortic gas
	Amorphous periaortic mass/collection
	Rapid expansion (days)
	Rupture
	Location in an atypical aortic segment (for example, paravisceral)
	Multiple aneurysms

Source: compiled by the authors, 2021.

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Primary infectious aortic aneurysm: a case series and review of the literature

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[1] Conflicts of interest: No conflicts of interest declared concerning the publication of this article.