A Case of EVAR for Mycotic Aneurysm Rupture
- VernacularTitle:感染性腹部大動脈瘤破裂に対し腹部大動脈ステントグラフト内挿術を行った1例
- Author:
Masahiro HIRANO
1
;
Hiroshi TSUNEYOSHI
1
;
Chikara UEKI
1
;
Ken YAMANAKA
1
;
Hirofumi SATO
1
Author Information
- Keywords: mycotic aneurysm; rupture; EVAR; psoas muscle abscess
- From:Japanese Journal of Cardiovascular Surgery 2019;48(1):69-72
- CountryJapan
- Language:Japanese
- Abstract: We report a case of mycotic aneurysm treated with endovascular aneurysm repair (EVAR). An 80-year-old man was admitted to a local hospital with high fever and lower back pain. Pyogenic spondylitis and psoas muscle abscess were diagnosed. Klebsiella pneumoniae was confirmed by blood culture. Treatment with intravenous antibiotics was not effective and contrast computed tomography (CT) scan showed an enlargement of the abscess and an abdominal aortic rupture. The patient was immediately transferred to our hospital. Laboratory tests showed an elevated C-reactive protein (12.3 mg/dl) and WBC (10,400/μl). Mycotic abdominal aneurysm rupture was diagnosed by CT scan. He underwent an emergency EVAR with an Excluder® (aorta extender). Intraoperative angiography showed a ruptured abdominal aorta. After operation, he was treated with intravenous minocycline and ampicillin, and the size of the abscess reduced without any endoleak on enhanced CT imaging. After intravenous antibiotics therapy for 4 weeks, we switched to oral antibiotics (minocycline and ciprofloxacin) and continued them for 6 months. As of 2 years after the surgery, there are no signs of infection or recurrence.
