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Purpose: Brucella aneurysms are very rare but life-threatening, and a standard treatment approach has yet to be established. The current study aimed to assess the safety and efficacy of endovascular treatment for Brucella aneurysms., Materials and Methods: The clinical data of 15 Brucella aortic-iliac aneurysm patients who underwent endovascular repair at 2 hospitals from January 2012 to December 2021 were retrospectively collected and analyzed., Results: Fifteen patients (12 men and 3 women) with a mean age of 59.3 years were included. Fourteen patients (93.3%) had a history of exposure to animals (cattle and sheep). All patients had aortic or iliac pseudoaneurysms, 9 abdominal aortic aneurysms (AAAs), 4 iliac aneurysms, and 2 AAA combined with iliac aneurysms. Endovascular aneurysm repair (EVAR) was performed in all patients without conversion to open surgery. Six cases were treated for emergency surgery due to aneurysm rupture. The immediate technique success rate was 100%, with no postoperative death. Two cases had the iliac artery ruptured again after operation because of lack of antibiotic treatment and was given endovascular treatment again. Once brucellosis is diagnosed, antibiotic treatment with doxycycline and rifampicin was initiated for all the patients until 6 months after operation. All patients survived over a median follow-up period of 45 months. Follow-up computed tomography angiography showed that all stent grafts remained patent, with no endoleak., Conclusion: EVAR combined with antibiotics treatment is feasible, safe, and effective for Brucella aneurysms and represents a promising treatment option for these Brucella aneurysms., Clinical Impact: Brucella aneurysms are very rare but life-threatening, and a standard treatment approach has yet to be established. The traditional operation management strategy is surgical resection and debridement of the infected aneurysm and the surrounding tissues. However, open surgical management in these patients causes severe trauma with high surgical risks and mortality (13.3%-40%). We tried to treat Brucella aneurysms with endovascular therapy, and the technique success and survival rate of the operation reached 100%. EVAR combined with antibiotics treatment is feasible, safe, and effective for Brucella aneurysms and represents a promising treatment option for some mycotic aneurysms., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Objective: Endografts (eg, aortic aneurysm device or covered stent) are increasingly being used to temporize or treat arterial and graft infections in inaccessible areas, in patients with compromised anatomy, or in the presence of active bleeding or rupture. This summary examines the evidence for "in situ" endografting in the treatment these conditions., Methods: A two-level search strategy of the literature (MEDLINE, PubMed, Google Scholar, and The Cochrane Library) was performed for relevant articles listed between January 2000 and December 2015. The review was confined to patients with primary and secondary bacterial or viral arterial infections, with or without fistulization and infection of bypass grafts and arteriovenous accesses. For the purposes of this summary, endografts can be considered to be an aortic aneurysm device or a covered stent., Results: There are no societal guidelines. Endografts have been successfully applied to mycotic arterial aneurysms, aortoenteric, aortobronchial, and arterioureteric fistulae, and to anastomotic bleeds secondary to infection. Multiple reports indicate success at the control of hemorrhage in all locations. Short-term outcomes are good, but fatal infection-related complications, especially if antibiotic therapy is halted, are well reported and necessitate a more definitive plan for the long term., Conclusions: Stent grafts remain an important and viable option for the treatment of mycotic aneurysms, aortoesophageal and aortobronchial fistulae, and infected pseudoaneurysms in anatomically or technically inaccessible locations. In patients with a short life span (<6 months), no further intervention is generally required. In patients with a predicted life span >6 months, careful consideration should be given to a more definitive procedure. Life-long appropriate antibiotic therapy is strongly recommended for any patient receiving an endograft in an infected field., (Copyright © 2017 Society for Vascular Surgery. Published by Elsevier Inc. All rights reserved.)

We report our experience with the urgent treatment of two high-risk patients with infected femoral artery pseudoaneurysms (IFAPs) with the placement of a self-expandable covered stent (SECS). In both cases, there was no perioperative mortality and the aneurysm exclusion was successful without early or late stent thrombosis/stent fracture nor acute or chronic limb ischemia or limb loss. There was no recurrence of local or systemic infection during the follow-up period. Endovascular therapy represents a feasible treatment option for IFAPs in those patients for whom the risk of open surgical repair would be prohibitive, especially under urgent circumstances.

A 69-year-old man underwent carotid artery stenting through the right femoral artery with a percutaneous vascular closure device for hemostasis. Eleven days later, an infective femoral artery pseudoaneurysm was diagnosed by computed tomography. At surgery, a defect in the femoral artery was observed, corresponding to the remnants of the closure device. Removal of the foreign material, debridement, wound irrigation, and arterial patch plasty were performed, but the infection and leg ischemia did not improve. After several failed attempts to revascularize and control the infection, obturator foramen bypass was performed. The postoperative course was uneventful, indicating the usefulness of this procedure.

Although not currently available in the United States, multilayer stents have been used successfully to treat a variety of aneurysms. These stents promote laminar flow and depressurize the aneurysmal portion of the vessel, while preserving side branch vessel flow. A conceivable benefit of the multilayer stent is in the treatment of infected pseudoaneurysms, given the absence of a fabric covering, a potential nidus for colonization. Here we present the case of a 64-year-old woman with symptomatic, enlarging infrarenal mycotic pseudoaneurysms who was successfully treated with an in vivo multilayer stent created by the layering of three concentric bare-metal Wallstents (Boston Scientific, Natick, Mass)., (Copyright © 2015 Society for Vascular Surgery. Published by Elsevier Inc. All rights reserved.)

Treatment of infection-induced aortic aneurysms is among the greatest challenges nowadays of vascular surgery because the use of prosthetic material is considered unsuitable. The Cardiatis multilayer stent (Cardiatis, Isnes, Belgium) is a flow-diverting bare stent with a proven efficacy in peripheral and visceral artery aneurysms. We present a unique case of a Salmonella serotype enteritidis-induced rapidly expanding aortic pseudoaneurysm with a penetrating ulcer that was treated with the Cardiatis multilayer stent. At 18 months of follow-up, the patient was in good clinical condition, with normalized C-reactive protein levels. Computed tomography angiography and 2-deoxy-2-[F18]-fluoro-d-glucose-positron-emission tomography/computed tomography showed a stable, mostly thrombosed aneurysm, with adequate perfusion of the side branches and no remaining signs of infection., (Copyright © 2014 Society for Vascular Surgery. Published by Elsevier Inc. All rights reserved.)

A 60-year-old male patient presented with a false aneurysm of the common iliac artery and methicillin-resistant Staphylococcus aureus septicemia complicating previously placed kissing covered stents of the aortic bifurcation. We removed the prosthetic material and repaired the aortic bifurcation with a composite saphenous vein panel graft. To our knowledge, this technique is presented for the first time in the literature., (Copyright © 2014 Society for Vascular Surgery. Published by Mosby, Inc. All rights reserved.)

Objective: The objective of the paper is to present a case of an infected bare metal stent in the left common iliac artery that was removed by an urgent operation, and to review the literature on diagnosis and outcome of infected coronary and non-coronary metal stents., Methods: A systematic search of the Medline database was performed with the purpose of identifying risk factors, signs and symptoms, imaging strategies, and treatment modalities of bare metal stent infections, both coronary and peripheral., Results: In total, 76 additional studies/case reports (48 non-coronary; 29 coronary) were included and analyzed. Intravascular bare metal stent infections are a rare but serious complication, often leading to emergency surgery (overall: 75.3%; non-coronary cases: 83.3%; coronary cases: 62.1%). In 25.0% of the non-coronary cases, infection led to amputation of an extremity or removal of viscera. Reported mortality was up to 32.5% of the cases (non-coronary: 22.9%; coronary 48.3%). Physicians should always be suspicious of a stent infection when patients present with aspecific symptoms such as fever and chills after stent placement. Additional imaging can be used to detect the presence of a pseudoaneurysm. A PET-CT is an ideal medium for identification of a stent infection., Conclusions: Intravascular stent infection is associated with a high risk of morbidity and mortality. Surgery is the preferred treatment option, but not always possible, especially in patients with a coronary stent. In selected cases, bare metal stent infections may be prevented by the use of prophylactic antibiotics at stent placement., (Copyright © 2013 European Society for Vascular Surgery. Published by Elsevier Ltd. All rights reserved.)

Mycotic aneurysms in the aortic arch are extremely rare and represent a challenging surgical problem. Although surgery is the standard treatment, application of endovascular repair has been extended, but this technique carries a concern regarding the interposition of an artificial graft in the infected lesion. We present the case of an infected pseudoaneurysm in the thoracic aorta which was successfully excluded by treatment with a stent graft., (Georg Thieme Verlag KG Stuttgart · New York.)

Mycotic pseudoaneurysms are relatively infrequent entities, and the best means of management of them remain to be elucidated due to their small number and medical complexities surrounding them. We present here an interesting case of a mycotic pseudoaneurysm of the superficial femoral artery along with our management of the case and a brief review of the available literature. The particular presentation of this patient will hopefully reinforce the use of prolonged antibiotic therapy for mycotic disease and judicious reexamination of patients whose clinical picture does not immediately fit the framework of our most common diagnoses.

The outcomes of reconstructive repair operations for aneurysms of the descending portion of the thoracic aorta typically appear to be relatively satisfactory. However, a certain cohort of patients presenting with the pathology concerned require repeated secondary interventions due to the development of false aneurysms in the area of the anastomosis and infection of the synthetic vascular stent graft, with the number of such patients steadily increasing with each year. The authors describe herein a clinical case report regarding successful treatment of a patient diagnosed with an infected pseudoaneurysm of the descending portion of the thoracic aorta after an endovascular repair operation. This case report demonstrated a present-day approach to appropriate treatment of patients presenting with the pathology involved.

Background: Pseudoaneurysms of the superior mesenteric artery are rare, and their natural history is characterized by their tendency to rupture, thereby leading to a high mortality rate. Compared with classic surgical techniques (open), in recent years the possibility of endovascular treatment has increased., Results: We report the cases of two patients with a pseudoaneurysm of the superior mesenteric artery. Each case was successfully treated in a different way: open and endovascular surgery., Conclusion: Despite the advantages (less risk for the patient) and good results obtained with endovascular surgery, this cannot completely replace open surgery. The choice of the most appropriate therapeutic option for pseudoaneurysms of the superior mesenteric artery depends on the state of the patient and the characteristics of the lesion. Open and endovascular surgical techniques are complementary, not mutually exclusive, techniques., (Copyright (c) 2010. Published by Elsevier Inc.)

Background: Infection of a renal artery stent and pseudoaneurysm is extremely uncommon, with four reports in the literature. We present a fifth case and the complex management resulting in kidney salvage., Methods and Results: A 56-year-old female underwent right renal artery stenting for hypertension. Postoperatively, she developed methicillin-resistant Staphylococcus infection, treated with antibiotics. Eight-month follow-up duplex ultrasound revealed a right renal artery pseudoaneurysm just distal to the stent. Computed tomography angiography (CTA) showed 2.8 cm proximal and 4.2 cm distal mycotic aneurysms. Antibiotics and planning angiogram were prescribed. A Chevron incision and duodenal kocherization were employed. The aorta below the superior mesenteric artery and below the renal vein was mobilized, as were the right renal artery and vein, hepatic artery, and saphenous vein. Following heparinization, the aorta was cross-clamped, as was the right renal artery at the hilum. The kidney was infused with cold saline. The renal artery stent was explanted, and aneurysmectomy was performed. The renal artery ostium was oversewn. A renal artery to hepatic artery saphenous vein bypass was fashioned, and patency was confirmed with intraoperative duplex ultrasound. Postoperatively, creatinine was normal, renal scan showed the right kidney to be functional, and duplex ultrasound showed a patent bypass graft. The patient was discharged on postoperative day 11 on long-term antibiotics. Eight-month follow-up duplex and CTA showed a patent bypass and durable repair., Conclusion: Renal artery stent infection with pseudoaneurysm is rare and can be diagnosed with duplex ultrasound. Renal salvage can be obtained but requires stent removal and autologous bypass grafting., (Copyright 2010. Published by Elsevier Inc.)

We report a successful repair of a ruptured tuberculous pseudoaneurysm of the descending thoracic aorta by endovascular stent graft placement. This procedure is starting to be accepted as an alternative method to surgery, and we review similar cases in the literature.

Mycotic false aneurysm caused by local arterial injury from attempted intravenous injections in drug addicts remains a challenging clinical problem. The continued increase in drug abuse has resulted in an increased incidence of this problem, particularly in high-volume urban centres. In the drug-abusing population, mycotic arterial pseudoaneurysms most often occur because of missed venous injection and are typically seen in the groin, axilla, and antecubital fossa. Mycotic aneurysms may lead to life-threatening haemorrhage, limb loss, sepsis, and even death. Any soft-tissue swelling in the vicinity of a major artery in an intravenous drug abuser should be suspected of being a false aneurysm until proven otherwise and should prompt immediate referral to a vascular surgeon for investigation and management. We report a case of rupturing mycotic pseudoaneurysm of the left common femoral artery treated by surgical resection followed by vessel reconstruction with autologous material. Unfortunately, at the time of discharge a sudden leakage from the vein graft anastomosis occurred, with subsequent massive bleeding, and required emergent endovascular covered stenting. To the best of our knowledge, this is the first reported case of femoral artery bleeding in a drug abuser treated by stent graft placement.

Mycotic aortic aneurysms remain a therapeutic challenge, especially in patients who are not suitable for open surgery. Endovascular treatment with stent-grafts in this indication is still disputed. Between January 2002 and January 2006, six patients with mycotic aneurysms of the thoracoabdominal or abdominal aorta were admitted to our department. All patients were male, aged 57-83 years (mean, 74.6 years). The mycotic aneurysms were diagnosed on the basis of clinical signs of infection, on CT, and, in four cases, on a positive blood culture. In all patients the mycotic aortic aneurysms were treated endovascularly by stent-graft implantation. Technical and clinical success was achieved in all patients. There was no in-hospital or 30-day mortality. In the follow-up period (range, 2-47 months) four patients died of cancer, cardiac failure, or unknown cause (one case). Two patients are still alive with nearly complete regression of the aneurysms. We conclude that treatment of mycotic aortic aneurysms with stent-grafts may be an alternative in selected patients.

A 74-year-old man presented with a ruptured infected anastomotic femoral pseudoaneurysm. Due to severe medical comorbidities he was considered unsuitable for conventional surgical management and underwent an emergency endovascular repair with a balloon-expandable covered stent. The pseudoaneurysm was excluded successfully and the patient had an uneventful postoperative recovery with long-term suppressive antimicrobials. He remained well for 10 months after the procedure with no signs of recurrent local or systemic infection and finally died from an acute myocardial infarction. To our knowledge, emergency endovascular treatment of a free ruptured bleeding femoral artery pseudoaneurysm has not been documented before in the English literature. This case illustrates that endovascular therapy may be a safe and efficient alternative in the emergent management of ruptured infected anastomotic femoral artery pseudoaneurysms when traditional open surgery is contraindicated.

Mycobacterium tuberculosis infection is one of the leading causes of death from communicable diseases worldwide. However, the incidence of leaking thoracic aortic tuberculous pseudoaneurysms is rare as a complication. Conventional treatment of a leaking tuberculous pseudoaneurysm involves surgery with graft interposition or patch repair. With the emergence of stent graft treatment as a viable option for leaking pseudoaneurysms, we report a 63-year-old man who had his leaking toracic aortic tuberculous pseudoaneurysm treated with endovascular stent grafting.

Percutaneous transluminal angioplasty and endovascular stent placement are becoming common techniques for iliac artery stenosis and obstruction that are intended to reduce the need for surgical bypass procedures. The usual complications include acute or subacute thrombosis, distal embolization, dissection, and extravasation. Although stent infection is very rare after stent replacement, it is reportedly associated with a high risk of morbidity and mortality, and the use of prophylactic antibiotics should be considered. We present a case of rupture of an infected pseudoaneurysm at the site of the external iliac artery that occurred 4 months after an uneventful percutaneous transluminal angioplasty and stent placement.

Introduction: Aortic aneurysms are a well known but rare complication of tuberculosis. Their major complication is aneurysmal rupture, unforeseeable and lethal., Exegesis: Chest pain and hemoptoic expectoration revealed a false aneurysm of the aortic isthmus in a 48-year-old man. Endovascular repair with a stent graft was urgently undertaken. Tuberculosis was diagnosed 6 weeks thereafter by the growth of gastric juice cultures and medically treated. Most tuberculous aortic aneurysms are false aneurysms, caused by an adjacent tuberculous focus eroding the aortic wall. They present with pain, bleeding or as para-aortic masses., Conclusion: Tuberculous false aneurysms of the aorta necessitate an early intervention before they rupture. Surgical treatment remains the preferred option but endovascular repair with a stent graft is a therapeutic alternative, to be considered in high-risk surgical patients.

Coronary artery stent infection is a rare complication of percutaneous intervention. We report a case of fulminant coronary stent infection with Staphylococcus aureus presenting as a pseudoaneurysm of the left circumflex artery following repeated implantation of drug-eluting stents in the setting of multiple episodes of recurrent in-stent restenosis. We speculate that sirolimus- and paclitaxel-eluting stents may be more likely to predispose to infection than bare metal stents because of their immunomodulating and antiproliferative effects., ((c) 2006 Wiley-Liss, Inc.)

Objective and Importance: Covered stenting of the carotid artery has been used to treat aneurysms and dissections. We describe a unique case of covered stenting in the setting of an infected psuedoaneurysm in a previously placed cervical-to-petrous vein bypass graft. Operating in an infected field and reopening a surgical wound at the craniocervical junction that had previously been exposed to penetrating trauma created substantial risks to open surgical repair. We therefore chose an endovascular strategy to repair this lesion., Clinical Presentation: A 57-year-old diabetic man with a previously placed cervical-to-petrous vein bypass graft presented with chronic otitis media and acute hemorrhage from his right external auditory meatus. Evaluation revealed an infectious pseudoaneurysm of the vein graft at the skull base., Technique: The patient was treated with intravenous antibiotics and endovascular placement of an 8-mm x 25-mm polytetrafluoroethylene-covered stent across the pseudoaneurysm. Angiography obtained 8 months later confirmed successful obliteration of the lesion., Conclusion: The patient's clinical outcome was excellent. Despite the active infection, covered stenting of the pseudoaneurysm was an effective treatment strategy, obviating the need for open debridement and graft revision.

Infections at the site of coronary stents are uncommon, and believed to be the result of either direct stent contamination at the time of delivery, or from transient bacteraemia from the access site. A case of pseudoaneurysm ("mycotic" aneurysm) of the left anterior descending coronary artery, due to infection with Staphylococcus aureus after paclitaxel-eluting stents implantation is presented.

A 48-year-old woman with severe juvenile-onset rheumatoid arthritis presented with a bleeding cutaneous sinus distal to her right total hip replacement scar. Methicillin resistant Staphylococcus aureus (MRSA) was isolated on culture. She had previously undergone bilateral total hip and knee replacements at aged 23 and six years later had the right knee prosthesis removed for infection, with subsequent osteomyelitis of the femoral shaft and right total hip prosthesis disruption. Peripheral arteriography was performed in view of persistent bleeding from the sinus, which revealed a 6 cm false aneurysm filling from and compressing the right external iliac artery (EIA). A PTFE-covered, balloon expandable JOSTENT was deployed in the right EIA, successfully excluding the false aneurysm and preventing further bleeding from the sinus. No graft infection was reported at 12 months. This case illustrates the potential use of endovascular stent-grafting in the treatment of an infected pseudoaneurysm.

Purpose: To report the benefit of endoluminal repair of mycotic aortic aneurysms and highlight the need for a registry., Methods: Nine patients (five female) were identified over 5 years (1998-2003) as having presumed mycotic aortic aneurysms (12 in total) suitable for endoluminal grafting. A total of nine thoracic and three abdominal were grafted and followed up for a median of 36 months., Results: Six of the aneurysms have resolved and one was converted to an open repair. There was one early death from rupture of a second undiagnosed aneurysm and two late deaths from rupture due to persistent inflammation. Long-term antibiotics have not been mandatory to ensure survival., Conclusions: Mycotic aortic aneurysms of the thoracic and abdominal aorta do benefit from endoluminal repair, particularly when arising in previously normal aortic tissue. Endoluminal grafting also has a role in the palliation of secondarily infected aortas and so to prove its efficacy in the treatment of all these rare cases a registry is required.

Purpose: To report the successful endovascular repair of a mycotic paravisceral aneurysm using a fenestrated stent-graft., Methods and Results: A 55-year-old white female with a history of rheumatoid arthritis presented with an 8-cm paravisceral aneurysm secondary to pneumonia complicated by empyema. Intravascular ultrasound identified a defect in the aortic wall at the level of the celiac axis. Repair was accomplished with a fenestrated stent-graft that excluded the aneurysm and maintained flow to the celiac axis and superior mesenteric artery. Recovery was uneventful and the patient was discharged in 2 days. Six-month follow-up computed tomographic scanning confirmed aneurysm exclusion and flow to the celiac and superior mesenteric arteries. There was no evidence of graft infection. The patient died from a clinically diagnosed myocardial infarction 10 months after the stent-graft repair., Conclusions: Fenestrated stent-graft repair may evolve into a useful technique for the treatment of mycotic paravisceral aneurysms.

Technically uncomplicated percutaneous angioplasty and stent placement of a left subclavian artery stenosis was performed in a 56-year-old man for treatment of subclavian steal syndrome and vertebrobasilar insufficiency. Six days later the patient was readmitted with Staphylococcus aureus bacteremia and stigmata of septic emboli isolated to the ipsilateral hand. Nine days later he had computed tomography (CT) evidence of a contrast-enhancing phlegmon surrounding the stent. Despite clinical improvement and resolution of bacteremia on intravenous antibiotic therapy, the phlegmon progressed, and at day 21 a pseudoaneurysm was angiographically confirmed. The patient underwent surgical removal of the stented arterial segment and successful autogenous arterial reconstruction. The possible contributory factors leading to stent infection were prolonged right femoral artery access and an infected left arm venous access. Although the role of prophylactic antibiotics remains to be defined, it may be important in cases where the vascular access sheath remains in place for a prolonged period of time.