Cryptococcal aortitis presenting as a ruptured mycotic abdominal aortic aneurysm.
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Mycotic processes occasionally complicate atherosclerotic aortic disease and usually require aggressive surgical therapy to control sepsis and prevent arterial rupture. Rarely, fungal organisms are responsible for primary infection of the abdominal aorta. We report the first case of Cryptococcal aortitis presenting as a ruptured abdominal aortic aneurysm. The surgical, pathologic, and microbiologic aspects of fungal aortitis are discussed. (+info)
Inflammatory abdominal aortic aneurysm: A postoperative course of retroperitoneal fibrosis.
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PURPOSE: The long-term outcome and the development of retroperitoneal fibrosis after surgery on an inflammatory aortic aneurysm was studied. METHODS: Between 1989 and 1997, 1035 patients underwent surgery for an abdominal aneurysm, 42 of whom (4.1%) had typical signs of inflammation. All patients underwent computed tomography (CT) scans before operation, and 26 patients were followed up with a CT scan after a median of 36 months (range, 10 to 91 months). RESULTS: The inflammatory layer resolved completely in only 23% of the patients. One patient had marked progression, 35% of patients showed improvement, and the remaining patients had no change, compared with the preoperative findings. Although clinical symptoms subsided in 90% of patients, in five cases an involvement of the ureter or intestine that did not exist at the time of operation developed. Although ureteral involvement to the inflammation tends to subside after surgery, persisting fibrosis was associated with ureteral entrapment in 30% of these cases and resulted in renal compromise in 49%. Hydronephrosis that was not present at the time of operation was found in 19% of patients, despite improving or stable inflammatory lesions. CONCLUSION: This case-control study supports the findings that retroperitoneal fibrosis persists longer than previously thought, and progression might even occur. Formerly uninvolved organs might become included in the process despite regression of the layer, leading to considerable problems if the condition is not treated in institutions familiar with this complex disease. We advocate a moderated follow-up scheme, as in the case of ordinary abdominal aortic aneurysm, and the need for long-term surveillance of inflammatory aneurysms. (+info)
Aortitis due to Salmonella: report of 10 cases and comprehensive review of the literature.
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We describe ten cases of aortitis due to Salmonella that were treated at the University of Toronto-affiliated Hospitals between 1978 and 1997. Predisposing conditions included hypertension, diabetes mellitus, and myelodysplastic syndrome. Main presenting symptoms were fever and abdominal and back pain. The most frequent site involved was the abdominal aorta, followed by the thoracic aorta. All but one patient were treated with intravenous bactericidal antibiotics; seven also underwent surgery, four with axillobifemoral grafts and three with in situ grafts. Four of seven patients died within 1 month of the surgical procedure (three patients with in situ grafts and one patient with axillobifemoral graft). We also reviewed the pathogenesis, clinical and laboratory characteristics, and treatment of 140 cases of aortitis due to Salmonella reported in the literature since 1948. The use of bactericidal antibiotics, together with early surgical intervention and long-term suppressive antibiotic therapy, has led to improved survival. (+info)
Aortic valve replacement for aortic regurgitation caused by aortitis.
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Between January 1984 and December 1998, 19 patients (16 with Takayasu's arteritis, 3 with non-Takayasu's aortitis) underwent surgical treatment for aortic regurgitation resulting from the aortitis. Of the 19 patients, 14 had aortic valve replacement (AVR) and 5 had aortic root replacement. One patient (5.3%) died of graft infection during the hospital stay. During the follow-up period, 1 (5.6%) of the 18 postoperative patients died of paravalvular leakage due to valve detachment, which also required redo-operations in 2 patients with non-Takayasu's aortitis. Both patients were operated on during the active phase of the inflammation without perioperative steroid therapy. Although transmural pledgeted sutures were used for replacement of the detached prosthetic valve in 1 of these 2 patients, disruption of the aortic wall resulted in recurrence of valve detachment. In the other patient, aortic root replacement was successfully performed with the Cabrol technique in the second operation. Perioperaitve steroid therapy plays an important role in preventing complications after AVR when the valve replacement is carried out during the active phase of the inflammation, and for patients with non-Takayasu's aortitis, aortic root replacement should be considered to reduce the tension on the suture line and the native aortic valve annulus. (+info)
Unusual complications in an inflammatory abdominal aortic aneurysm.
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An unusual case of an inflammatory abdominal aortic aneurysm (IAAA) associated with coronary aneurysms and pathological fracture of the adjacent lumbar vertebrae. The associated coronary lesions in cases of IAAA are usually occlusions. In the present case, it was concluded that a possible cause of the coronary aneurysm was coronary arteritis and the etiology of the pathological fracture of the lumbar vertebrae was occlusion of the lumbar penetrating arteries due to vasculitis resulting in aseptic necrosis. Inflammatory AAA can be associated with aneurysms in addition to occlusive disease in systemic arteries. The preoperative evaluation of systemic arterial lesions and the function of systemic organs is essential. (+info)
Fifteen-year experience of transperitoneal management of inflammatory abdominal aortic aneurysms.
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OBJECTIVES: to assess the long-term outcome of patients with inflammatory abdominal aortic aneurysms. MATERIALS AND METHODS: over a fifteen-year period 598 cases of abdominal aortic aneurysm were treated and, of these, 32 cases (5.3%) were inflammatory in nature. The diagnosis was made on preoperative (CT) computed tomography in fifteen cases. Twenty-six patients were symptomatic on presentation and ten cases were repaired on an emergency basis. Only six were repaired electively. The transabdominal transaortic approach without dissection on the nearby adherent structures was used routinely. RESULTS: there was one postoperative death from a respiratory arrest leading to a thirty-day mortality of 3.1%. Early graft thrombosis occurred in three cases (9.3%) and all underwent successful thrombectomy. Colonic ischaemia was encountered in one patient who later developed an aortoenteric fistula. Two patients suffered a non-fatal myocardial infarction postoperatively leading to an overall morbidity of 18.7%. CONCLUSIONS: patients with inflammatory aortic aneurysms fare worse than patients with aortic aneurysms in general. Preoperative suspicion assists in planning surgery. We believe that the transperitoneal approach with an anterolateral aortotomy and minimal dissection of adherent structures offers excellent results in dealing with this difficult group of patients. (+info)
A patient with fever and an abdominal aortic aneurysm.
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A 55-year-old man with an abdominal aortic aneurysm presented with fever and abdominal pain 3 weeks after an episode of Salmonella gastroenteritis. His symptoms persisted despite antimicrobial therapy. Two abdominal computed tomography (CT) scans showed no evidence of aortitis. His abdominal pain worsened and further investigation including a third CT scan demonstrated a leaking aortic aneurysm. The wall of the aorta was shown to contain Gram-negative bacilli. This case illustrates the difficulty in diagnosing bacterial aortitis. (+info)
Papulonecrotic tuberculide and stenosis of the abdominal aorta.
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Papulonecrotic tuberculide (PNT) is a rare form of skin tuberculosis affecting predominantly young adults, with a history of immunity to Mycobacterium tuberculosis. We report a case of a young Caucasian female with PNT who was also documented to have a stenotic segment in the abdominal aorta. The difficulty in clarifying and treating the primary disease and the association between a tuberculous infection and Takayasu's arteritis are discussed. (+info)