In situ replacement with equine pericardial roll grafts for ruptured infected aneurysms of the abdominal aorta.

Mycotic aneurysms of the common carotid artery (CCA) are very rare and warrant surgical treatment to prevent rupture and death. A 89-year-old man who complained of a sore throat and swelling of the right side of neck. He had no history of trauma or neck infection. Physical examination revealed hard and pulsatile mass. Computed tomography showed initially pseudoaneurysm rupture on the right CCA with surrounding inflammation. The emergency operation revealed mycotic aneurysm rupture with CCA necrosis and was successfully done by wide debridement and carotid artery resection with interposition bypass. The resected tissue and blood culture grew growth of Staphylococcus aureus group. We report a rare case of mycotic aneurysm of right CCA that treated by bypass interposition.

Ruptured Mycotic Aneurysm of the Common Carotid Artery: A Case Report.

We describe the influence of methicillin-resistant Staphylococcus aureus (MRSA) bacteremia on histopathological alteration of a glutaraldehyde-fixed equine pericardial roll (EPR) graft in a 77-year-old male who underwent in-situ EPR replacement of a ruptured infected abdominal aorta with concomitant repair of the perforated duodenum. The patient died of circulatory failure after septic shock due to MRSA infection and gastrointestinal bleeding on postoperative day (POD) 23. The autopsy revealed no perforation of the EPR graft or anastomotic disruption between the native abdominal aorta and EPR graft. Histological examination revealed that the inner layer of the EPR graft was colonized and damaged by Gram-positive cocci (MRSA suspected). We therefore suggest that the infection-resistant property of EPR grafts may be uncertain in patients with postoperative sustained MRSA bacteremia when these grafts are used for arterial reconstruction.

Vulnerability of an equine pericardial roll graft to Gram-positive cocci after graft replacement for a ruptured infected abdominal aorta.

We report a case in which conventional and endovascular exclusion techniques were used to treat ongoing mycotic aortic aneurysmal disease. A 51-year-old man presented with an infrarenal mycotic aortic aneurysm that was excluded and reconstructed with a superficial femoral vein. Two years later, he developed a symptomatic mycotic aneurysm of the descending thoracic aorta, which required emergent treatment with a stent graft. The patient died 5 months later of massive bleeding owing to an aortobronchial fistula deriving from a new thoracic aneurysm proximal to the stent graft. Choices and different modes of treatment are discussed. Endovascular treatment of symptomatic mycotic aortic aneurysm might provide a valid alternative to open repair but may be unsuccessful owing to ongoing infection. In situ replacement using autologous material seems appealing whenever feasible.

Conventional or endovascular treatment of ongoing mycotic aortic aneurysmal disease

Ruptured Mycotic Aortic Aneurysm

Primary autologous superficial femoral vein reconstruction of an emergency, infected, ruptured aortic aneurysm.

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Primary autologous superficial femoral vein reconstruction of an emergency, infected, ruptured aortic aneurysm.