rifampin and Aortic-Aneurysm--Thoracic

Coxiella burnetii, the etiologic agent of Q fever, has been associated with vascular infection and aneurysm formation. We report the case of a 36-year-old woman from Iraq who presented with long-standing malaise as well as vague chest and shoulder discomfort and was found to have a saccular aneurysm of the descending thoracic aorta. Serology assays were positive for chronic C burnetii infection. She was treated with successful aneurysm resection and aortic replacement with a rifampin-impregnated Maquet Hemashield (TM) Dacron interposition graft interposition graft in addition to 18 months of doxycycline and hydroxychloroquine. The patient is without evidence of recurrent infection on follow-up at 3 years. To our knowledge, this is the first case of aortic aneurysm secondary to Q fever reported in the United States. We review the diagnosis, surgical management, antibiotic therapy, and surveillance of a thoracic aortic aneurysm secondary to Q fever.

Topics: Adult; Aneurysm, Infected; Anti-Bacterial Agents; Aortic Aneurysm, Thoracic; Aortography; Blood Vessel Prosthesis; Blood Vessel Prosthesis Implantation; Coated Materials, Biocompatible; Computed Tomography Angiography; Coxiella burnetii; Doxycycline; Female; Humans; Hydroxychloroquine; Prosthesis Design; Q Fever; Rifampin; Time Factors; Treatment Outcome

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

Mycotic thoracic aortic aneurysms are a life-threatening diagnosis and carry a high risk of morbidity and mortality in the perioperative setting. Traditional open repair consists of debridement, drainage, and either in situ or extra-anatomic bypass. Acute rupture portends a dismal prognosis; however, emergent endovascular repair of ruptured mycotic aneurysms has been described in the literature and we present a case of successful endovascular treatment of a ruptured mycotic descending thoracic aortic aneurysm.. We report the case of a 42-year-old male with hypertension and active intravenous drug use who presented with 3 weeks of chest pain, dyspnea, and hemoptysis, and on computed tomography scan was found to have a contained 4.1-cm ruptured mycotic thoracic aortic aneurysm. Blood cultures were positive for methicillin-resistant Staphylococcus aureus. Emergent repair was recommended because of likelihood of further rupture and death. Thoracic endovascular aortic repair (TEVAR) was performed using a rifampin-soaked stent graft without complication. At 2-year follow-up, the patient was asymptomatic and imaging demonstrated the stent graft in excellent position, without endoleak, and complete resolution of the aneurysm sac.. TEVAR can be safely employed to treat a ruptured mycotic thoracic aneurysm when open repair is not possible because of patient's comorbidity or complex rupture, as these patients face imminent death. Long-term follow-up is necessary for detection of endoleak, recurrence, or propagation of the aneurysm, and persistent bacterial infections.

Topics: Adult; Aneurysm, Infected; Anti-Bacterial Agents; Aortic Aneurysm, Thoracic; Aortography; Blood Vessel Prosthesis; Blood Vessel Prosthesis Implantation; Coated Materials, Biocompatible; Emergencies; Endovascular Procedures; Humans; Male; Methicillin-Resistant Staphylococcus aureus; Prosthesis Design; Rifampin; Staphylococcal Infections; Stents; Time Factors; Tomography, X-Ray Computed; Treatment Outcome

The objective of this report is to discuss the efficacy of in situ replacement for treating mycotic aneurysm, particularly using rifampicin-bonded grafts and omental pedicle grafts, on the basis of our 7 years of experience.. Between December 2003 and December 2010, we performed surgical treatments in 23 patients (for the thoracic aorta in 6 patients, for the thoracoabdominal aorta in 8 patients, and for the abdominal aorta in 9 patients; 7 emergency, 10 urgent, and 6 elective operations) with mycotic aneurysm by using rifampicin-bonded grafting and omental pedicle grafting.. One patient died in hospital because of local recurrent infection. One patient required an additional operation on another aortic site, and 3 patients had spinal cord injuries (2 transient and 1 permanent). Overall survival at 5 years was 95%, and the rate of freedom from aortic events at 5 years was 86%.. In situ replacement using rifampicin-bonded grafting and omental pedicle grafting is effective for treating mycotic aneurysms of the thoracic and abdominal aorta.

Topics: Aged; Aged, 80 and over; Aneurysm, Infected; Anti-Bacterial Agents; Aortic Aneurysm, Abdominal; Aortic Aneurysm, Thoracic; Bacteremia; Blood Vessel Prosthesis Implantation; Combined Modality Therapy; Elective Surgical Procedures; Enterobacteriaceae Infections; Female; Gram-Positive Bacterial Infections; Humans; Male; Middle Aged; Omentum; Polyethylene Terephthalates; Retrospective Studies; Rifampin; Stents; Surgical Flaps; Treatment Outcome

We report a patient, which we believe is the first, with a thoracoabdominal aortic aneurysm, Crawford type IV, caused by Q fever (Coxiella burnetii). Treatment consisted of antibiotic therapy started preoperatively and continued postoperatively and an open repair, including resection of the infected aneurysm, replacement with a rifampin-soaked polyester graft, and an omental wrap covering the grafts. After 13 months of follow-up, the patient had no signs of infection, and results of laboratory findings were normal.

Topics: Aneurysm, Infected; Anti-Bacterial Agents; Aortic Aneurysm, Thoracic; Aortography; Blood Vessel Prosthesis; Blood Vessel Prosthesis Implantation; Coated Materials, Biocompatible; Coxiella burnetii; DNA, Bacterial; Humans; Male; Middle Aged; Omentum; Polyesters; Prosthesis Design; Q Fever; Rifampin; Surgical Flaps; Tomography, X-Ray Computed; Treatment Outcome

We reported successful distal repair using the frozen elephant trunk technique to treat a mycotic aneurysm extending from the ascending aorta to the descending aorta. A blood culture sample was positive for Escherichia coli, and total arch replacement with a rifampicin-bonded graft covered the omental pedicle flap.

Topics: Aged, 80 and over; Aneurysm, Infected; Anti-Bacterial Agents; Aortic Aneurysm, Thoracic; Aortography; Blood Vessel Prosthesis; Blood Vessel Prosthesis Implantation; Coated Materials, Biocompatible; Escherichia coli; Humans; Male; Omentum; Prosthesis Design; Rifampin; Stents; Surgical Flaps; Tomography, X-Ray Computed; Treatment Outcome

Mycotic aortic aneurysms are rare but are associated with high morbidity and mortality due to their propensity for rupture. Traditional therapy consists of open surgical repair with resection and aortic reconstruction or extra-anatomic bypass combined with long-term antibiotic therapy.. An 85-year-old male with persistent bacteremia was found to have a descending mycotic aortic aneurysm. Surgical options were discussed and endovascular treatment was recommended with stent-graft placement followed by intra-aortic rifampin infusion. This approach led to resolution of the aneurysm and eradication of bacteremia at 4-month follow-up.. By combining traditional surgical strategies with a contemporary endovascular approach, the perioperative mortality and long-term risk of infection associated with mycotic thoracic aneurysms can potentially be decreased.

Topics: Aged, 80 and over; Aneurysm, Infected; Anti-Bacterial Agents; Aortic Aneurysm, Thoracic; Aortography; Blood Vessel Prosthesis; Blood Vessel Prosthesis Implantation; Combined Modality Therapy; Endovascular Procedures; Humans; Male; Prosthesis Design; Rifampin; Staphylococcus aureus; Stents; Suction; Tomography, X-Ray Computed; Treatment Outcome

Mycotic aneurysms located on aortic arch are rare and have extremely high mortality. The presented case is a 75-year-old man with a thoracic aortal mycotic aneurysm successfully treated with surgical intervention. To prevent recurrent infection and postoperative pulmonary complications, we performed single-stage surgery including extensive debridement, graft replacement using rifampicin soaked prosthetic graft and omental wrapping. Although mycotic aneurysm with inflammation tissue usually interferes with surgical manipulation because of severe adhesion to the lung, semi-clamshell approach helped us perform all these procedures. The patient rapidly recovered from the surgery, and has shown no recurrence after 35 months follow-up.

Topics: Aged; Aneurysm, Infected; Anti-Bacterial Agents; Aortic Aneurysm, Thoracic; Aortography; Blood Vessel Prosthesis; Blood Vessel Prosthesis Implantation; Debridement; Humans; Male; Omentum; Prosthesis Design; Rifampin; Surgical Flaps; Tomography, X-Ray Computed; Treatment Outcome

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

We report a case of an aortobronchial fistula causing massive hemoptysis, which was managed by emergency stent grafting. Although this procedure was successful initially, the aortobronchial fistula appeared again 7 months later. Aneurysmectomy, followed by rifampicin-soaked gelatin sealed polyester graft replacement and omentopexy, was performed under cardiopulmonary bypass. The patient, a 73-year-old woman, had an uneventful postoperative course and the infection was eradicated.

Topics: Aged; Aneurysm, Infected; Aorta, Thoracic; Aortic Aneurysm, Thoracic; Aortic Rupture; Blood Vessel Prosthesis; Bronchial Fistula; Cardiopulmonary Bypass; Endovascular Procedures; Enzyme Inhibitors; Female; Hemoptysis; Humans; Leprostatic Agents; Prognosis; Rifampin; Stents; Tomography, X-Ray Computed; Vascular Fistula

A 70-year-old female who had undergone pancreato-duodenectomy 1 month before, presented with back pain. Computed tomography (CT) revealed a saccular aneurysm in the distal aortic arch (40 mm in diameter) and she was referred to our department. Despite proper antibiotic treatment, CT revealed progressive enlargement of the aneurysm and operation was performed. The aneurysm was treated by debridement of the infected aortic tissue and in situ replacement with a rifampicin-soaked vascular prosthesis through L-incision approach. After surgery, antibiotics were administrated intravenously for 1 month, followed by oral antibiotics. The patient is doing well 1 year after the operation.

Topics: Aged; Aneurysm, Infected; Aorta, Thoracic; Aortic Aneurysm, Thoracic; Blood Vessel Prosthesis; Female; Humans; Rifampin

A 76-year-old female presented with constipation and anorexia Computed tomography (CT) revealed a saccular aneurysm (35 mm in diameter) directly over the root of the celiac artery, and she was referred to our department and was admitted. Klebsiella pneumoniae was detected in blood culture. Although antibiotics were administered, the inflammatory response was not improved. On day 8 after hospitalization, CT revealed the aneurysm increased. Therefore, surgery was performed. Aneurysm was observed adjacent to the celiac artery. The excised aorta included the descending thoracic aorta and the superior mesenteric artery, and was replaced with a rifampicin-soaked Vasctec Gelweave 24 mm vascular graft with branches. After hemostasis, omental implantation was performed around the vascular graft. Before surgery, sufficient antibiotics administration is desirable to bring the infection under control. However, if infection is uncontrollable with progressive enlargement of the aneurysm, as in this case, surgery is unavoidable. A combination of treatments was successful.

Topics: Aged; Aneurysm, Infected; Antibiotics, Antitubercular; Aortic Aneurysm, Abdominal; Aortic Aneurysm, Thoracic; Blood Vessel Prosthesis Implantation; Female; Humans; Klebsiella Infections; Klebsiella pneumoniae; Omentum; Rifampin; Tomography, X-Ray Computed; Treatment Outcome; Vascular Surgical Procedures

A 64-year-old woman was admitted due to back pain and dyspnea. She was suffering from fever of unknown origin for a few weeks without aortic aneurysm by enhanced chest computed tomography (CT). Chest CT taken 1 month later revealed rupture of aortic arch aneurysm. Total arch replacement was performed with in situ grafting under selective cerebral perfusion combined with deep hypothermic circulatory arrest. Rifampicin (RFP) was sprinkled on the graft at operation and omentopexy was done 5 days after the 1st operation. Methicillin-resistant Staphylococcus aureus (MRSA) was isolated on the culture of the aneurysmal wall, therefore, polymyxin B immobilized fiber with direct hemoperfusion (PMX-DHP) was also conducted with antibiotic therapy. Her clinical course after the 2nd operation was uneventful with no infective complication. We report a successful case of ruptured aneurysm of aortic arch infected with MRSA and review our strategy as one of feasible options without using homograft or preparative RFP-bonded vascular prosthesis.

Topics: Aneurysm, Infected; Aortic Aneurysm, Thoracic; Aortic Rupture; Blood Vessel Prosthesis Implantation; Diagnostic Imaging; Female; Humans; Intraoperative Care; Methicillin Resistance; Middle Aged; Rifampin; Staphylococcal Infections; Staphylococcus aureus

Aortoesophageal fistula secondary to thoracic aneurysm is rare, but is usually lethal, and few survivors have been reported. We report successful surgery for aortoesophageal fistula in a one-stage operation. Repair involved in situ replacement of the thoracic aneurysm using a rifampicin-soaked graft, primary repair of the esophagus, omental wrap and tube jejunostomy. This is the original report of the surgical repair of aortoesophageal fistula using a rifampicin-soaked graft.

Topics: Anti-Infective Agents; Aortic Aneurysm, Thoracic; Aortic Diseases; Blood Vessel Prosthesis; Blood Vessel Prosthesis Implantation; Enteral Nutrition; Esophageal Fistula; Esophagoscopy; Esophagus; Humans; Jejunostomy; Omentum; Prosthesis Design; Prosthesis-Related Infections; Rifampin; Surgical Flaps; Tomography, X-Ray Computed; Treatment Outcome; Vascular Fistula

To present a case of successful emergency endovascular repair of a ruptured, probably mycotic, thoracoabdominal aortic aneurysm (TAAA) with a stent-graft deliberately covering the celiac axis.. A 79-year-old woman with significant pulmonary comorbidity presented with a ruptured mycotic TAAA extending to the celiac axis. The aneurysm was excluded with a stent-graft soaked in rifampicin and deployed to deliberately occlude the celiac axis for effective distal sealing and fixation. The patient recovered well and was prescribed antibiotic treatment for up to 6 months.. Endovascular repair of a ruptured TAAA may be a life-saving option. In emergency situations when poor distal anatomy is present, covering the celiac artery with the stent-graft should be considered.

Topics: Abdominal Pain; Aged; Aneurysm, Infected; Angiography; Angioplasty, Balloon; Anti-Bacterial Agents; Antibiotics, Antitubercular; Aortic Aneurysm, Abdominal; Aortic Aneurysm, Thoracic; Aortic Rupture; Blood Vessel Prosthesis Implantation; Celiac Artery; Diarrhea; Emergencies; Fatigue; Female; Fever; Humans; Patient Selection; Prosthesis Design; Rifampin; Stents; Tomography, X-Ray Computed; Treatment Outcome

A 73-year-old man was admitted for investigation of back pain, blood-stained sputum, and a high fever. Computed tomography (CT) showed a pseudoaneurysm in the descending aorta and intravenous antibiotic therapy was begun immediately after blood had been taken for culture. However, his temperature continued to spike daily, up to 38 degrees C, and his CRP was also elevated. The blood cultures were negative. The aneurysm ruptured and we replaced the descending aorta with a rifampicin (RFP)-soaked vascular prosthesis, and wrapped it with greater omentum. Postoperative antibiotic therapy with vancomycin hydrochloride, RFP, and amikacin sulfate was continued for 8 weeks. The patient recovered uneventfully. Thus, an infected aneurysm was effectively treated with a RFP-soaked vascular prosthesis and omentopexy.

Topics: Aged; Aneurysm, Infected; Aorta, Thoracic; Aortic Aneurysm, Thoracic; Aortic Rupture; Blood Vessel Prosthesis; Blood Vessel Prosthesis Implantation; Humans; Male; Omentum; Rifampin