rifampin and Aneurysm--False

An 80-year-old man presented with a fast expanding 9.5-cm mycotic arch pseudoaneurysm. The right axillary and femoral arteries were cannulated. Through sternotomy, a reverse zone 2 arch replacement was performed with a 28-mm rifampin-soaked Hemashield aortic graft (Maquet, Wayne, NJ) graft with circulatory arrest. A 30-mm Coda balloon (Cook Medical, Bloomington, IN) was used to occlude the descending aorta, and the lower body was perfused through the femoral artery. The infected pseudoaneurysm was débrided and irrigated. A separate 28-mm rifampin-soaked Dacron graft was anastomosed to the proximal-descending aorta. The left subclavian artery was anastomosed to the proximal Dacron graft. Finally, the proximal and distal Dacron grafts were anastomosed together.

Topics: Aged, 80 and over; Aneurysm, False; Aorta, Thoracic; Aortic Aneurysm, Thoracic; Blood Vessel Prosthesis Implantation; Humans; Male; Perfusion; Polyethylene Terephthalates; Rifampin

We describe a case of successful treatment of mycotic pseudoaneurysm of the transverse aortic arch in a male infant. The aneurysm was resected and the defect was repaired using a patch made from a rifampicin-impregnated Dacron graft.

Topics: Airway Obstruction; Aneurysm, False; Aneurysm, Infected; Antibiotics, Antitubercular; Aorta, Thoracic; Follow-Up Studies; Humans; Infant; Male; Polyethylene Terephthalates; Postoperative Complications; Retrospective Studies; Rifampin; Treatment Outcome; Vascular Surgical Procedures

A 76-year-old woman had a chest pain and high fever, and was admitted to the intensive care unit diagnosed as acute pericarditis. Enhanced CT-scan showed a 47-mm aneurysm in the aortic arch which seemed to be impending rupture and the part of the aorta looked like a pseudoaneurysm. Emergent total aortic arch replacement with a rifampicin-bonded Dacron graft was performed. Pericardial effusion was purulent and the aorta was infected with pus discharge in the aortic wall. There were some ulcerations on the surface of the luminal wall of the aorta. One of them was penetrating into the pericardial space causing a pseudoaneurysm. Both pericardial effusion and excised aortic wall were sent to culture study and resulted in positive for Streptococcus pneumoniae. The infection of the aorta, with erosion into the pericardial space, seemed to be the cause of purulent pericarditis. Antibiotic therapy was commenced immediately after surgery and continued for four weeks. Though she had neurological deficit after surgery, her infection was well controlled and there was no recurrence of infection 11 months after surgery.

Topics: Aged; Aneurysm, False; Aneurysm, Infected; Anti-Bacterial Agents; Aortic Aneurysm, Thoracic; Aortography; Blood Vessel Prosthesis; Blood Vessel Prosthesis Implantation; Coated Materials, Biocompatible; Combined Modality Therapy; Drug Therapy, Combination; Female; Humans; Penicillin G; Pericardial Effusion; Pericarditis; Pneumococcal Infections; Polyethylene Terephthalates; Prosthesis Design; Rifampin; Tomography, X-Ray Computed; Treatment Outcome

A 59-year-old man had undergone aortic root replacement for annuloaortic ectasia (AAE) and aortic regurgitation (AR) 18 years before. The computed tomography (CT) showed a pseudoaneurysm of ascending aorta 4 years after the 1st operation. Re-aortic root replacement was done 15 years after the 1st operation because of the pseudoaneurysm. However, 3 years after the 2nd operation, the patient suffered from fever and another pseudoaneurysm was revealed by CT. Echocardiography showed a vegetation attached to the aortic valve. The 3rd operation was successfully performed using rifampicin-soaked vascular prosthesis. The postoperative course was uneventful. Thus, graft infection was effectively treated with a rifampicin-soaked vascular prosthesis.

Topics: Aneurysm, False; Aneurysm, Infected; Antibiotics, Antitubercular; Blood Vessel Prosthesis; Humans; Male; Middle Aged; Prosthesis-Related Infections; Rifampin

Pseudoaneurysm of the femoral artery is an extremely rare complication of tuberculosis. We present a case of tuberculous femoral pseudoaneurysm that was successfully treated with resection, direct anastomosis, and postoperative antituberculous chemotherapy.

Topics: Aged; Aged, 80 and over; Anastomosis, Surgical; Aneurysm, False; Aneurysm, Ruptured; Antibiotics, Antitubercular; Antitubercular Agents; Ethambutol; Femoral Artery; Humans; Isoniazid; Magnetic Resonance Angiography; Male; Rifampin; Tuberculosis, Cardiovascular