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OBJECTIVES: Mycotic aortic aneurysm is a rare but life threatening disease. It carries a high mortality rate due to the risk of rapid expansion and rupture. Although open repair is the gold standard, recent literature has suggested a role for endovascular repair in high risk patients. Long term follow up data on patients that have undergone endovascular repair is limited. We present a case of successful treatment and remodeling of mycotic aneurysm of the descending thoracic aorta at 2-year follow up.
METHODS: A 62 year-old man presented with a new-onset asymptomatic pseudoaneurysm in the distal descending thoracic aorta identified on CT scan. He had recent history of Methicillin sensitive Staphylococcus Aureus bacteremia from an infected chemotherapy port. Repeat CT at one week after developing symptoms showed rapidly expanding mycotic aneurysm of the descending thoracic aorta. Patient underwent Thoracic Endovascular Aneurysm Repair (TEVAR) with peri-operative antibiotics. Patient was placed on lifelong suppressive antibiotic treatment with serial CT scan follow up.
RESULTS: Patient remains asymptomatic after 2 years of follow up. Serial CT scans up to 2-year interval show complete remodeling of the aneurysm around the endograft without any clinical or imaging evidence of active infection. Blood cultures were rendered negative by the initial antibiotic therapy.
CONCLUSIONS: This case illustrates that complete treatment of infection and excellent remodeling of aneurysm can be achieved by treatment of mycotic aortic aneurysm using endovascular stent graft along with antibiotic therapy. The result is durable at long term follow up without the need for delayed open surgery. We discuss possible factors at initial presentation that could predict successful treatment of infection and remodeling of mycotic aortic aneurysms, when treated with endovascular stent grafts.