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Endovascular treatment of aortitis

Vasileios Rafailidis, Sasan Partovi, Alexander Dikkes, Dean A Nakamoto, Nami Azar, Daniel Staub
Ultrasound (US) represents the initial modality in the workup of abdominal aortic pathology based on the plethora of advantages including widespread availability, low cost, safety profile and repeatability. However, US has inherent limitations including limited spatial information of pathologic processes to neighboring structures, lower sensitivity to slow blood flow and aortic luminal irregularities. For evaluation of aortic pathology angiography has long been considered the gold standard. Non-invasive cross-sectional imaging techniques like computed tomography angiography (CTA) and magnetic resonance angiography (MRA) have gradually replaced interventional angiography for the evaluation of aorta, currently being regarded as the diagnostic imaging modalities of choice for diagnosis of virtually every aortic disease...
April 2018: Cardiovascular Diagnosis and Therapy
William Curtis, Motoyo Yano
Acute pathology in the abdominal aorta is associated with significant morbidity and mortality. The most feared complication of abdominal aortic disease is acute rupture in the setting of atherosclerotic abdominal aortic aneurysm. Although frank rupture often is easily diagnosed on CT, other findings such as a hyperattenuating crescent, discontinuous intimal calcium, and draping of the aorta are subtle signs of aneurysm instability. A true aneurysm should be distinguished from a rapidly growing, saccular pseudoaneurysm in the setting of infectious aortitis, as treatment strategy differs...
May 2018: Abdominal Radiology
Hitoshi Ogino
In some instances, we encounter cases suffered from inflammatory aortic diseases (aortitis) in Japan, some of which are at the active stages with systemic inflammation. Most of them are refractory with some technical difficulties of surgical treatment. The aortic wall, particularly, at the active stage, is too fragile to hold the surgical sutures. Consequently, the suture reinforcement with Teflon felt is required. In the late stage after surgery, false aneurysms on the suture line, that is, suture detachment potentially occur...
February 5, 2018: General Thoracic and Cardiovascular Surgery
H Ben Jmaà, R Karray, H Jmal, T Cherif, F Dhouib, I Souissi, A Karoui, Z Bahloul, S Masmoudi, N Elleuch, I Frikha
Non-infectious aortitis is usually due to giant-cell arteritis, Takayasu disease or Behçet disease. The main aortic lesions are stenoses, occlusions and aneurysms in the Takayasu disease and aneurysms in the Behçet disease and giant-cell arteritis. Treatment is based on corticosteroid therapy and surgery. Endoluminal management is now the rule. We report a retrospective descriptive study of 10 patients who underwent surgical or endoluminal management of inflammatory lesions of the aorta between January 2000 and December 2015...
July 2017: Journal de Médecine Vasculaire
Philippe Tresson, Arnaud Roussel, Pierre Mordant, Pierre Cerceau, Yves Castier, Quentin Pellenc
Invasive aspergillosis rarely involves the thoracic aorta and is associated with a poor prognosis. A 56-year-old heart transplant recipient presented with invasive aspergillosis, primary Aspergillus aortitis, and a ruptured thoracic aorta pseudoaneurysm. Open surgical repair was not possible because of severe sepsis. Therefore, a sequential surgical strategy was planned, including emergency thoracic endovascular aortic repair, followed by antifungal treatment and definitive open repair with explantation of the endograft and placement of a cryopreserved arterial allograft under extracorporeal membrane oxygenator support...
December 2017: Annals of Thoracic Surgery
Toshihide Tomosugi, Takuji Takahashi, Yoshihisa Kawase, Koichi Yoshida, Shogo Hayashi, Takefumi Sugiyama, Mitsuya Shimizu, Michita Shoka, Kohichi Sawaki, Eiji Onishi, Naomi Hayashi, Hidenobu Matsushita, Osamu Okochi
Aneurysm formation is a potential complication of granulomatosis with polyangiitis (GPA), previously known as Wegener's granulomatosis. It is a very rare complication, but immediate diagnosis and therapy should be performed because an aneurysm can be life-threatening if it ruptures. An accessory left gastric artery (ALGA) is also a rare variant gastric artery that may obtain its blood supply from the left hepatic artery and left gastric artery. We herein describe a 57-year-old Japanese man who was diagnosed with GPA complicated by aneurysm rupture in an ALGA...
February 2017: Nagoya Journal of Medical Science
Luca Mezzetto, Gian Franco Veraldi, Stephan Engelberger, Luca Giovannacci, Josua Van den Berg, Raffaele Rosso
Infective aortitis (IA) and penetrating aortic ulcer (PAU) impending for rupture represent 2 hostile life-threatening conditions. Simultaneous presentations of these rare entities can be considered an exception. The pleomorphic clinical presentation and the multifactorial etiology require a multidisciplinary approach to reach a correct diagnosis and an urgent treatment. We report the case of a 65-year-old patient presented with acute abdominal pain and septic shock secondary to a bacterial aortitis and penetrating ulcer of abdominal aorta...
August 2016: Annals of Vascular Surgery
N C Khang, A A Zainal
BACKGROUND: This is a single institutional review of aortoiliac pseudoaneurysm of various aetiologies managed with endovascular stent graft repair. METHODS: From 2009 to 2014, 16 patients had endovascular stent graft inserted for pseudoaneurysm of the thoracic aorta, abdominal aorta and iliac arteries in Hospital Kuala Lumpur. Co-morbidity, causative agents, in-hospital mortality, complications and outcomes were examined. RESULTS: The average age was 59...
February 2016: Medical Journal of Malaysia
D Vakhitov, V Suominen, J Korhonen, T Kuorilehto, J-P Salenius
AIM: To report a case of successful endovascular treatment of mycotic aneurysms of the inferior mesenteric artery and the aorta. CASE REPORT: Infrarenal aortitis in a 55-year-old multimorbid man resulted in formation of two mycotic aneurysms, one in the infrarenal aorta and the other in the inferior mesenteric artery. The patient was treated with a bifurcated aortic endograft. Antibiotic therapy was continued postoperatively for one year. Shrinkage of both aneurysms was obtained with no signs of infection or endoleaks at five year follow-up...
2016: Angiologii︠a︡ i Sosudistai︠a︡ Khirurgii︠a︡, Angiology and Vascular Surgery
C Del Giudice, J-M Alsac, M Sapoval
Aortitis is an inflammation of the aortic wall with an infectious or non-infectious origin, which often progresses to vascular complications. The open surgical approach is a high-risk procedure for these pathologies. Endovascular interventions have improved the prognosis of patients with aortitis complications. This manuscript describes the pathophysiology responsible for vascular complications and the role of endovascular approach for their treatment.
April 2016: La Revue de Médecine Interne
J Gaudric, M Dennery, C Jouhannet, N Kagan, D Saadoun, L Chiche, F Koskas
Non-infectious aortitis are usually due to giant cell arteritis (temporal arteritis), Takayasu and Behçet's diseases. Aortitis should be suspected in the presence of aortic wall thickening or of aneurysm or occlusion of the aorta and its branches in the absence of characteristic cardiovascular risk factors. Surgery is required in case of severe damage. But the quiescence of the inflammatory disease must be obtained before endovascular or surgical treatment to prevent complications such as anastomotic false aneurysm or stent thrombosis, especially common in this disease...
April 2016: La Revue de Médecine Interne
A-C Desbois, B Wechsler, P Cacoub, D Saadoun
The arterial lesions affect about 10% of patients with Behçet's disease (BD). Aortic inflammatory involvement includes predominantly aortic aneurysmal lesions affecting most often the abdominal aorta. They account for the severity of the disease and are a leading cause of death when they hit the aorta or pulmonary arteries. Within the arterial lesions of BD, aortic involvement is, with femoral lesions, the most common site involved (18-28% of patients with vascular disease). Unlike other large vessels vasculitis (i...
April 2016: La Revue de Médecine Interne
Jay J Idrees, Eric E Roselli, Charles M Wojnarski, Ke Feng, Muhammad Aftab, Douglas R Johnston, Edward G Soltesz, Joseph F Sabik, Lars G Svensson
OBJECTIVE: Staged elephant trunk (ET) repair is a commonly performed procedure for extensive aortic disease. A significant proportion of patients with predominantly proximal aortic pathology often have in addition a moderately dilated descending aorta (<5 cm) that can progress over time. Objectives were to characterize patients, determine completion rate after prophylactic stage 1 ET, and assess outcomes. METHODS: From 1992 to 2012, a total of 572 patients underwent stage 1 ET for degenerative aneurysm and dissection at Cleveland Clinic...
November 2015: Journal of Thoracic and Cardiovascular Surgery
Arshiya Tabasum, Robert Bleehen, Brendan Healy, Lindsay George
Clostridium septicum (CS) is a rare organism that accounts for only 1.3% of all clostridial infections. However, its detection is of great clinical significance, as over 80% of cases are associated with malignancy, often occult; the most common primary sites are the ascending colon and caecum, and the most common cause is haematological malignancy. We report a case of a 79-year-old woman, admitted with shortness of breath and left-sided chest pain, who, following subsequent investigations, was found to have CS aortitis...
September 15, 2015: BMJ Case Reports
A Kahlberg, G Melissano, Y Tshomba, M Leopardi, R Chiesa
Infectious thoracic aortitis is a rare disease, especially since the incidence of syphilis and tuberculosis has dropped in western countries. However, the risk to develop an infectious aortitis and subsequent mycotic aneurysm formation is still present, particularly in case of associated endocarditis, sepsis, and in immunosuppressive disorders. Moreover, the number of surgical and endovascular thoracic aortic repairs is continuously increasing, and infective graft complications are observed more frequently...
April 2015: Journal of Cardiovascular Surgery
Eetu Niinimaki, Henri Kajander, Timo Paavonen, Thanos Sioris, Ari Mennander
Definitive treatment of extended thoracic aortic dilatation is a major surgical challenge. Histopathology of resected thoracic aortic wall may reveal undiagnosed aortitis affecting outcome. We sought to investigate the benefit of thorough histopathology after one-stage corrective surgery for the treatment of extended thoracic aortic dilatation. Five patients underwent one-stage corrective surgery using the hybrid open arch repair by the frozen elephant trunk together with endovascular aortic grafting. A representative sample of the resected aortic arch was procured for histology...
June 2014: International Journal of Angiology: Official Publication of the International College of Angiology, Inc
Caroline Ovaert, Edouard Gitenay, Alain Fraisse
Diffuse aortitis, as seen in Takayasu disease, is characterised by extreme wall fragility, associated with a high risk of complications such as dissection and aneurysm formation, following endovascular treatment. We report a patient with Takayasu disease who presented with a very difficult clinical course associated with several unfavourable outcomes of stent insertion.
April 2015: Cardiology in the Young
Parth J Parekh, Rouzbeh Shams, Vaishnavi Challapallisri, Paul E Marik
We report a case of a 77-year-old Asian man with a history significant for type II diabetes mellitus and chronic kidney disease who presented with abdominal pain, nausea, vomiting and a 20-pound weight loss of 3 weeks' duration. Further evaluation revealed an infected mycotic aneurysm and distal abdominal aortitis as a result of Salmonella. This case demonstrates an interesting case of aortitis and a successful therapeutic approach.
June 10, 2014: BMJ Case Reports
Soumya Chatterjee, Scott D Flamm, Carmela D Tan, E Rene Rodriguez
Large vessel vasculitis (LVV) covers a spectrum of primary vasculitides predominantly affecting the aorta and its major branches. The two main subtypes are giant cell arteritis (GCA) and Takayasu arteritis (TA). Less commonly LVV occurs in various other diseases. Clinical manifestations result from vascular stenosis, occlusion, and dilation, sometimes complicated by aneurysm rupture or dissection. Occasionally LVV is discovered unexpectedly on pathological examination of a resected aortic aneurysm. Clinical evaluation is often unreliable in determining disease activity...
July 2014: Current Cardiology Reports
Amin Madani, Stephane Leung, Daniel Obrand
PURPOSE: The purpose of this report is to describe a novel endovascular technique used to minimize blood loss during the open repair of an aortocaval fistula (ACF) in the context of an inflammatory abdominal aortic aneurysm (AAA). CASE REPORT: We describe a patient who presented to our hospital with a symptomatic infrarenal AAA which was discovered intraoperatively to contain a large ACF. The patient underwent successful transperitoneal open repair of the AAA with balloon occlusion of the inferior vena cava to obtain distal control of the vessel...
January 2014: Vascular and Endovascular Surgery
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