Brucella aortitis managed with debridement, extra-anatomical bypass, and long-term antimicrobial therapy

Vascular ◽  
2021 ◽  
pp. 170853812110585
Author(s):  
John Perry ◽  
Hossam Alslaim ◽  
Gautam Agarwal
Keyword(s):  
Aortic Aneurysm ◽  
Retrospective Chart Review ◽  
Aortic Aneurysms ◽  
Type I ◽  
Oral Antibiotic ◽  
Oral Antibiotic Therapy ◽  
Type I Endoleak ◽  
Operative Debridement ◽  
History Of

Objectives This report aims to review the management and outcomes of Brucella-associated mycotic aortic aneurysms. Methods This is a retrospective chart review at a tertiary-level healthcare system. IRB approval was waived per policy. Results We describe a case of Brucella aortitis acquired from habitual contact with wild hogs. Clinical presentation included lower back pain and elevated white blood cell count. Diagnosis was confirmed with imaging showing an infrarenal abdominal aortic aneurysm and serology revealing elevated Brucella antibodies titers. The patient was initially managed with endovascular aortic repair and combined oral and intravenous antibiotics therapy. He then underwent explanation and extra-anatomical bypass due to symptomatic periaortic infection and interval development of type I endoleak. The patient was asymptomatic after his final operation at 24 months of follow-up and remained on suppressive oral antibiotic therapy. Conclusions An aortic aneurysm secondary to Brucella is a rare entity. A detailed history of long-term exposure to animals may be a clue to obtain serologic testing. Operative debridement and re-establishing of reliable blood flow combined with long-term antibiotic suppression are the mainstay of treatment.

Uncovered Chimney Stent Graft for Renal Arteries With the Nellix Endovascular Aneurysm Sealing Technique

2017 ◽  
Vol 52 (2) ◽  
pp. 148-153 ◽  
Author(s):  
Luca Garriboli ◽  
Antonio Maria Jannello
Keyword(s):  
Aortic Aneurysms ◽  
Type I ◽  
Abdominal Aortic ◽  
Vessel Patency ◽  
Type I Endoleak ◽  
Procedural Costs ◽  
Endovascular Approach ◽  
Access Complications

Purpose: To describe the application of uncovered chimney stent grafts with the Nellix endovascular aneurysm sealing technique (ChEVAS) for juxtarenal abdominal aortic aneurysms (JAAAs). Case Report: Two patients with JAAA and multiple comorbidities were considered unfit for open surgery and were selected for an endovascular approach. Fenestrated and branched endografts were too expensive, and a chimney endovascular approach was considered inappropriate for the relatively high incidence of proximal type I endoleak and graft migration. ChEVAS was performed successfully with the novel addition of uncovered chimney stents to further reduce costs and possibly improve target vessel patency. JAAA exclusion and visceral vessel patency was confirmed at 18-month follow-up. Conclusion: ChEVAS with bare chimney stents is technically less complex, potentially reduces access complications and procedural costs, and may improve long-term patency compared to alternative techniques. Results at 18 months seem promising, but strict follow-up is necessary as the long-term durability is unknown.

Treatment of complex aortic aneurysms with fenestrated endografts and chimney stent repair: Systematic review and meta-analysis

Vascular ◽  
2016 ◽  
Vol 25 (1) ◽  
pp. 92-100 ◽  
Author(s):  
Yang Yaoguo ◽  
Chen Zhong ◽  
Kou Lei ◽  
Xiao Yaowen
Keyword(s):  
Aortic Aneurysm ◽  
Meta Analysis ◽  
Endovascular Aneurysm Repair ◽  
Aortic Aneurysms ◽  
Type I ◽  
Type I Endoleak ◽  
Comprehensive Search ◽  
Aneurysm Repair ◽  
Related Mortality

Objective We reviewed data pertaining to fenestrated endograft technique and chimney stent repair of complex aortic aneurysm for comparative analysis of the outcomes. Methods A comprehensive search of relevant databases was conducted to identify articles in English, related to the treatment of complex aortic aneurysm with fenestrated endovascular aneurysm repair and chimney stent repair, published until January 2015. Results A total of 42 relevant studies and 2264 patients with aortic aneurysm undergoing fenestrated endovascular aneurysm repair and chimney stent repair were included in our review. A total of 4413 vessels were involved in these processes. The cumulative 30-day mortality was 2.4% and 3.2% ( p = 0.459). The follow-up aneurysm-related mortality was 1.4% and 3.2% ( p = 0.018), and target organ dysfunction was 5.0% and 4.0% in fenestrated endovascular aneurysm repair and chimney stent repair, respectively ( p = 0.27). A total of 156 vessels showed restenosis or occlusion after primary intervention (3.6% and 3.4% in fenestrated endovascular aneurysm repair and chimney stent repair, respectively, p = 0.792). The cumulative type I endoleak was 2.0% (38/1884) after fenestrated endovascular aneurysm repair compared with 3.4% (13/380) after chimney stent repair ( p = 0.092), and the type II endoleak was 5.4% (102/1884) and 5.3% (20/380), respectively ( p = 0.905). Approximately, 1.1% and 1.6% increase in aneurysm was observed following fenestrated endovascular aneurysm repair and chimney stent repair, respectively ( p = 0.437). The re-intervention frequency was 205 and 19 cases after fenestrated endovascular aneurysm repair and chimney stent repair, respectively (11.7%, 5.6%, p = 0.001). Conclusions Fenestrated endovascular aneurysm repair and chimney stent repair are safe and effective in treating patients with complex aortic aneurysm. A higher aneurysm-related mortality was observed in chimney stent repair while fenestrated endovascular aneurysm repair was associated with a higher re-intervention rate.

Abstract 269: Influence of Medical Therapy and Co-Morbidities on Long-Term Outcomes in Patients with Aortic Aneurysms

2013 ◽  
Vol 6 (suppl_1) ◽  
Author(s):  
Carl A Heinecke ◽  
Batyrjan Bulibek ◽  
Chandra Ojha ◽  
Lewis Britton ◽  
Mikhail Torosoff ◽  
...  
Keyword(s):  
Aortic Aneurysm ◽  
Medical Therapy ◽  
Beta Blockers ◽  
Aortic Aneurysms ◽  
Ca Channel ◽  
Long Term Outcomes ◽  
Social Security Death Index ◽  
History Of ◽  
Aneurysm Diameter

Background: We investigated effects of medical therapy and co-morbidities on long-term outcomes in patients with documented aortic aneurysms. Material and Methods: Medical records of 162 consecutive patients (64+/-13 years old, 37% females, 91% Caucasians) enrolled in the Aortic Aneurysm clinic at a single tertiary medical center were reviewed. Long-term outcomes (28+/-29 months) were determined using Social Security Death Index. ANOVA, chi-square, and logistic regression tests were employed. Results: Older patients (73+/-8.9 vs. 62+/-13, p=0.006; HR 2.1 per decade, 95%CI 1.2-3.6, p=0.008) or patients with larger aneurysm diameter (5.4+/-0.8 vs. 4.7+/-0.7, p=0.005; HR 3.8 per 1 cm, 95%CI 1.4-10.3, p=0.008) were more likely to die during the follow-up. There was a trend towards increased mortality when history of smoking was present (76% vs. 23% in non-smokers, p=0.042; HR 3.7, 95%CI 0.97-13.9, p=0.055). None of the 11 patients with atrial fibrillation expired (0 vs. 10% in NSR, p=0.273). Gender, body surface area, systolic and diastolic blood pressures on presentation, history of CAD, CHF, hypertension, diabetes, dyslipidemia, or renal disease had no discernible effects on mortality in our study cohort. There was a trend towards reduced mortality in patients treated with aspirin or clopidogrel (3.4% vs. 12.1%, p=0.064; HR 0.3, 95%CI 0.05-1.1, p=0.083), beta-blockers (5.4% vs. 10.4%, p=0.282; HR 0.5, 95%CI 0.13-1.85, p=0.290) and Ca-channel blocker (0% vs. 10.6%, p=0.067; HR 0.9, 95%CI 0.9-1.1, p=0.972). Treatment with ACE inhibitors or ARBs, statins, or diuretics did not affect the outcomes. In multivariate analysis only advanced age (HR 2.2, 95%CI 1.0-4.5, p=0.038) and larger aortic aneurysm diameter (HR 2.9 per 1 cm, 95%CI 0.9-9.1, p=0.069) were predictive of increased long-term mortality. Conclusions: In patients with documented aortic aneurysms mortality is largely determined by patient’s age and vessel diameter. When compared to vasodilators and diuretics, beta-blockers and Ca-channel blockers may be preferable in patients with aortic aneurysm. Treatment with anti-platelet agents is not detrimental and may have a potential to improve long-term outcomes.

Effects of long-term chloroquine administration on the natural history of aortic aneurysms in mice

2015 ◽  
Vol 93 (8) ◽  
pp. 641-648 ◽  
Author(s):  
Azza Ramadan ◽  
Mark D. Wheatcroft ◽  
Adrian Quan ◽  
Krishna K. Singh ◽  
Fina Lovren ◽  
...  
Keyword(s):  
Natural History ◽  
Thrombus Formation ◽  
Aortic Aneurysms ◽  
Ang Ii ◽  
Abdominal Aortic ◽  
Suprarenal Aorta ◽  
History Of ◽  
Categorical Distribution

Autophagy regulates cellular homeostasis and integrates the cellular pro-survival machinery. We investigated the role of autophagy in the natural history of murine abdominal aortic aneurysms (AAA). ApoE−/− mice were implanted with saline- or angiotensin II (Ang-II)-filled miniosmotic pumps then treated with either the autophagy inhibitor chloroquine (CQ; 50 mg·(kg body mass)–1·day–1, by intraperitoneal injection) or saline. Ang-II-elicited aneurysmal expansion of the suprarenal aorta coupled with thrombus formation were apparent 8 weeks later. CQ had no impact on the incidence (50% for Ang-II compared with 46.2% for Ang-II + CQ; P = NS) and categorical distribution of aneurysms. The markedly reduced survival rate observed with Ang-II (57.1% for Ang-II compared with 100% for saline; P < 0.05) was unaffected by CQ (61.5% for Ang-II + CQ; P = NS compared with Ang-II). CQ did not affect the mean maximum suprarenal aortic diameter (1.91 ± 0.19 mm for Ang-II compared with 1.97 ± 0.21 mm for Ang-II + CQ; P = NS). Elastin fragmentation, collagen accumulation, and smooth muscle attrition, which were higher in Ang-II-treated mice, were unaffected by CQ treatment. Long-term CQ administration does not affect the natural history and prognosis of experimental AAA, suggesting that global loss of autophagy is unlikely to be a causal factor in the development of aortic aneurysms. Manipulation of autophagy as a mechanism to reduce AAA may need re-evaluation.

scholarly journals Miliary tuberculosis in a paediatric patient with psoriasis

2021 ◽  
Vol 14 (3) ◽  
pp. e237580
Author(s):  
Jacob Kilgore ◽  
Jonathon Pelletier ◽  
Bradford Becken ◽  
Stephen Kenny ◽  
Samrat Das ◽  
...  
Keyword(s):  
Brain Mri ◽  
Miliary Tuberculosis ◽  
Pulmonary Nodules ◽  
Chronically Ill ◽  
Community Acquired Pneumonia ◽  
Oral Antibiotic ◽  
Cavitary Lesion ◽  
Oral Antibiotic Therapy ◽  
History Of ◽  
Chest X Ray

We present a 16-year-old girl with a history of well-controlled psoriasis, on immunosuppression, who sought evaluation in the emergency department for 4 months of fever, cough and unintentional weight loss. The patient had seen multiple providers who had diagnosed her with community-acquired pneumonia, but she was unimproved after oral antibiotic therapy. On presentation, she was noted to be febrile, tachycardic and chronically ill-appearing. Her chest X-ray showed diffuse opacities and a right upper lobe cavitary lesion concerning for tuberculosis. A subsequent chest CT revealed miliary pulmonary nodules in addition to the cavitary lesion. The patient underwent subsequent brain MRI, which revealed multifocal ring-enhancing nodules consistent with parenchymal involvement. The patient was diagnosed with miliary tuberculosis and improved on quadruple therapy. Though rates of tuberculosis are increasing, rates remain low in children, though special consideration should be given to children who are immunosuppressed.

Real-World Experience with Type I Endoleaks after Endovascular Repair of the Thoracic Aorta

2010 ◽  
Vol 76 (6) ◽  
pp. 599-605 ◽  
Author(s):  
Joshua D. Adams ◽  
Margaret C. Tracci ◽  
Sahir Sabri ◽  
Kenneth J. Cherry ◽  
John F. Angle ◽  
...  
Keyword(s):  
Natural History ◽  
Thoracic Endovascular Aortic Repair ◽  
Spontaneous Resolution ◽  
Type I ◽  
Single Center ◽  
Type I Endoleak ◽  
History Of ◽  
Aortic Pathologies ◽  
Initial Results

Endoleaks are a frequent complication of thoracic endovascular aortic repair (TEVAR) and will likely increase in incidence with application of the technique to more complicated aortic anatomy and a wider range of thoracic aortic pathologies. Management generally consists of aggressive repair of Type I endoleaks; however, the natural history of Type I endoleaks after TEVAR remains largely unknown. The purpose of this study was to examine the incidence and characteristics of Type I endoleaks and to evaluate clinical outcomes of patients with Type I endoleaks after TEVAR. A single-center retrospective review was performed on all patients who underwent TEVAR over a 4-year period. Type I endoleaks were detected in 21 per cent (27 of 129) of patients on post-deployment aortography or CT angiography. During a mean follow-up of 750.63 ± 483 days, 59 per cent (16 of 27) closed spontaneously; 30 per cent (eight of 27) required secondary endovascular intervention; and 11 per cent (three of 27) have persisted with no increase in maximum aortic diameter. No patients have died or required open surgical conversion as a result of their Type I endoleak. Although accurate predictors of spontaneous resolution of Type I endoleaks have yet to be definitively characterized, our initial results suggest that it may be safe to observe small Type I endoleaks given that a large percentage resolve spontaneously and no endoleak-related deaths have occurred.

scholarly journals Trapeziometacarpal joint arthritis: A retrospective study of the natural history of symptomatic thumb arthritis

2019 ◽  
Vol 5 (2) ◽  
pp. 11
Author(s):  
Jessica Frankenhoff ◽  
Jeffrey Stromberg ◽  
Aimee Riley ◽  
Jun He ◽  
Prem Madesh ◽  
...  
Keyword(s):  
Natural History ◽  
Retrospective Chart Review ◽  
Treatment Modalities ◽  
Common Source ◽  
Average Pain ◽  
Average Pain Score ◽  
History Of ◽  
And Function ◽  
Joint Arthritis

Objective: Trapeziometacarpal (TM) joint arthritis is a common source of hand pain in patients presenting to the hand surgeon’s clinic. Long-term data on the natural history of symptomatic TM arthritis is lacking.Methods: We identified 251 patients with symptomatic TM arthritis and performed a retrospective chart review which identified treatment modalities (including surgery) and long term outcomes which were assessed via a telephone survey.Results: We found that of the 251 patients who presented with symptomatic TM arthritis, the 114 patients who had surgery had less pain and disability in the long term than those patients who were treated conservatively with splinting or injection (average pain score 1.8 vs. 3.8). However, the majority of patients did not ultimately undergo surgery.Conclusions: Although patients fare better from a pain and function standpoint with surgery, surgery is not inevitable.

Sign in / Sign up

Export Citation Format

Share Document