Tuberculous aortic aneurysm (TBAA) is an extremely rare clinical event with life-threatening implication. Management for this condition is challenging and its therapeutic option has not been yet established. A few recent reports described endovascular repair rather than open surgery as the method for treatment. Although this remains controversial, endovascular exclusion has been gaining acceptance for some surgeons. We present a case of TBAA who was treated by endovascular stent grafting for a descending thoracic aortic aneurysm with simultaneous anti-tuberculous medication. The outcome was favorable.
Adult ; Aneurysm, Infected ; drug therapy ; microbiology ; surgery ; Antitubercular Agents ; therapeutic use ; Aortic Aneurysm, Thoracic ; drug therapy ; microbiology ; surgery ; Humans ; Male

OBJECTIVETo analyze the death-related risk factors of type B aortic dissection treated medically during the acute phase (symptoms presenting within 14 d), and to determine the predictors of surgical indications for acute type B aortic dissection.

METHODSClinical data of 42 patients with acute type B aortic dissection admitted from January 2007 to May 2009 was retrospectively reviewed. There were 33 male and 9 female with a mean age of (50 +/- 12) years old. Therapy included analgesia, controlled hypotension and beta-receptor blocker, the mortality in acute phase was 33.3% (14/42). Univariate and multivariate logistic regression analyses were performed to identify the predictors of the death in acute phase.

RESULTSIn univariate logistic regression analysis, the malperfusion of aortic branches (P = 0.018) and maximum aortic diameter (P = 0.002) were significant predictors of death. In the multivariate logistic regression model, the malperfusion of aortic branches (P = 0.041) and maximum aortic diameter (P = 0.005) were also considered as the significant death-related factors.Risk of death augmented significantly (P = 0.000) when the maximum aortic diameter over 40 mm.

CONCLUSIONMalperfusion of aortic branches and the large maximum aortic diameter (> 40 mm) are the indications of surgery or endovascular therapy for acute type B aortic dissection.

Acute Disease ; Adult ; Aged ; Aneurysm, Dissecting ; drug therapy ; mortality ; Aortic Aneurysm ; drug therapy ; mortality ; Cause of Death ; Female ; Humans ; Logistic Models ; Male ; Middle Aged ; Retrospective Studies ; Risk Factors

The superficial femoral artery (SFA) is a relatively rare location for lower limb aneurysmatic disease. In the literature, this disease is described an association between a relatively high growth rate and/or the rupture of aneurysms and chemotherapeutic agents. We report a case of the rupture of a giant SFA aneurysm in a patient during chemotherapy for acute lymphatic leukemia.
Aneurysm* ; Arteries ; Drug Therapy* ; Femoral Artery* ; Humans ; Leukemia ; Lower Extremity ; Rupture*

An acute aortic thrombosis in the absence of atherosclerosis, aortic dissection, or aneurysm is an infrequent clinical entity and has been rarely reported in the literature. However, because of serious complications such as an embolism that can be fatal, one should always pay attention to the possibility of its occurrence. We report two cases of an acute aortic thrombosis of lung cancer patients treated with chemotherapy and a review of the literature.
Acute Disease ; Aneurysm ; Aorta ; Atherosclerosis ; Drug Therapy* ; Embolism ; Humans ; Lung Neoplasms ; Thrombosis*

Aneurysm, False ; surgery ; Factor VIII ; therapeutic use ; Hemophilia A ; drug therapy ; Humans ; Uremia

Studies have shown that chronic inflammatory response plays a key role in intracranial aneurysms (IA) formation and progression, and macrophages regulate the formation and progression of IA through a variety of pathways. Bone marrow monocyte-derived macrophages and resident-tissue macrophages infiltrate the vessel wall, after infiltration macrophages are polarized into various polarization phenotypes dominated by M1-like and M2-like cells. Polarized phenotypes of macrophages can regulate the formation and progression of intracranial aneurysms by releasing cytokines and regulating the inflammatory response of other immune cells, as well as release different cytokines to regulate the process of extracellular matrix remodeling. Some important progresses have been made in the clinical detection and treatment in targeting macrophages. This review provides a summary on the pathogenesis of IA and potential drug targets to prevent the formation and rupture of intracranial aneurysms.
Cytokines ; Disease Progression ; Humans ; Inflammation ; Intracranial Aneurysm ; complications ; drug therapy ; pathology ; Macrophages ; metabolism

A patient with Behcet's syndrome in whom multiple pulmonary artery aneurysms were completely resolved after a combined treatment with corticosteroid and chlorambucil is reported.
Aneurysm/*drug therapy ; Behcet Syndrome/*drug therapy ; Case Report ; Chlorambucil/*therapeutic use ; Drug Therapy, Combination ; Human ; Male ; Prednisone/*therapeutic use ; *Pulmonary Artery

INTRODUCTIONMycotic aneurysms are associated with high mortality rates and are managed in the local setting with extra-anatomical bypass followed by ligation, exclusion and debridement of the aneurysm. This is the first case of successful endovascular stenting in an immunocompromised patient with Salmonella mycotic aneurysm.

CLINICAL PICTUREA middle-aged man who was HIV positive had Salmonella septicaemia. He developed abdominal pain 5 days after admission and a computed tomography (CT) scan of the abdomen revealed infrarenal aortitis. He developed a mycotic aneurysm 3 weeks later.

TREATMENTHe opted for endovascular stenting and after prolonged antibiotic therapy and negative blood cultures, he underwent the procedure using a Talent stent, with an iliac extension.

OUTCOMEHe was discharged 1 week after stenting and maintained on oral bactrim based on sensitivity. At 1-year follow-up, he remains well symptomatically and CT scan showed no endoleak or collection.

CONCLUSIONEndovascular stenting, though a fairly new procedure, can be successfully deployed even in a mycotic aneurysm in the right setting.

Aneurysm, Infected ; drug therapy ; surgery ; therapy ; HIV Infections ; physiopathology ; Humans ; Male ; Middle Aged ; Salmonella Infections ; drug therapy ; microbiology ; surgery ; Salmonella enteritidis ; Stents ; Trimethoprim, Sulfamethoxazole Drug Combination ; therapeutic use

Tuberculous aneurysm of the aorta is exceedingly rare. To date, the standard therapy for mycotic aneurysm of the abdominal aorta has been surgery involving in-situ graft placement or extra-anatomic bypass surgery followed by effective anti-tuberculous medication. Only recently has the use of a stent graft in the treat-ment of tuberculous aortic aneurysm been described in the literature. We report two cases in which a tuberculous aneurysm of the abdominal aorta was success-fully repaired using endovascular stent grafts. One case involved is a 42-year-old woman with a large suprarenal abdominal aortic aneurysm and a right psoas abscess, and the other, a 41-year-old man in whom an abdominal aortic aneurysm ruptured during surgical drainage of a psoas abscess.
Adult ; Aneurysm, Infected/drug therapy/radiography/*surgery ; Antitubercular Agents/therapeutic use ; Aortic Aneurysm, Abdominal/drug therapy/radiography/*surgery ; *Blood Vessel Prosthesis Implantation ; Case Report ; Female ; Human ; Male ; Psoas Abscess/surgery ; *Stents ; Tuberculosis, Cardiovascular/drug therapy/radiography/*surgery

We report a case of ruptured mycotic aneurysm involving innominate artery requiring an urgent surgical treatment. A 62-yr-old woman presented with fever and dyspnea. Previously, she was diagnosed with colon cancer and received right hemicolectomy and one cycle of adjuvant chemotherapy. On echocardiogram, pericardial effusion was noted and emergency pericardiocentesis was performed. CT scan revealed aortic aneurysm involving ascending aorta and innominate artery, and thrombi surrounding those structures. Patch repair of the defect in the ascending aorta and ringed Goretex graft to bypass the innominate and ascending aorta were performed. We believe that this is the first case of ruptured mycotic aneurysm involving innominate artery.
Aneurysm, Infected/*surgery ; Aorta/pathology ; Aortic Aneurysm/surgery ; Brachiocephalic Trunk/pathology ; Colonic Neoplasms/drug therapy/surgery ; Female ; Human ; Middle Aged ; Tomography, X-Ray Computed ; Transplants