Departmental Bulletin Paper Long-term Antibiotics and Simple TEVAR for Treatment of Infectious Thoracic Aortic Aneurysm

Takahashi, Shinya  ,  Sueda, Taijiro  ,  Katayama, keijiro  ,  Watanabe, Masazumi  ,  Go, Seimei  ,  Morita, Shohei

66 ( 4 )  , pp.103 - 108 , 2017-12 , Hiroshima University Medical Press
Purpose: The principle treatment of infectious aortic aneurysm is to remove the infected aneurysm and replace it with Rifampicin-soaked prosthesis by omentopecxy. This study aimed to clarify the efficacy of long-term antibiotics and subsequent thoracic endovascular aneurysm repair (TEVAR) for infectious thoracic aortic aneurysm.Methods: Between July 2011 and December 2015, 213 TEVARs were performed at Hiroshima University Hospital. Six patients (2.8%) had infectious aneurysm and received long-term antibiotic therapy and secondary TEVAR. L ong-term antibiotic therapy and subsequent TEVAR is paradoxical. This study aimed to clarify the timing of TEVAR for infectious thoracic aortic aneurysm.Results: All patients presented with fever and back pain, and had positive blood cultures; five patients had significant co-morbidities. Bacteraemia was caused by Methicillin Sensitive Staphylococcus Aureus (MSSA) (2), Streptococcus sanguinis (1), Methicillin Resistant Staphylococcus Aureus (MRSA) (1), Chryseobacterium meningosepticum (1), and Enterococcus faecalis (1). B lood examination at admission revealed a WBC count ranging from 10,470 to 16,170/μl and CRP ranging from 7.9 to 16.4 mg/dl. Long-term antibiotic therapy was continued until WBC and CRP were within the normal range. TEVAR was performed emergently in 3 cases and electively in 3 cases. The time from admission to TEVAR ranged from 7 to 26 days. One stent-graft was deployed in all 6 cases. All patients survived and were followed for an average of 48 months; they were free from re-infection.Conclusion: Long-term antibiotics and simple TEVAR may be a feasible treatment for infectious thoracic aortic aneurysms.

Number of accesses :  

Other information