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International audience; We present a comprehensive and original framework for the biomechanical analysis of patients affected by ascending thoracic aorta aneurysm and aortic insufficiency. Our aim is to obtain crucial indications about the role played by deranged hemody-namics on the ATAAs risk of rupture. Computational fluid dynamics analysis was performed using patient-specific geometries and boundary conditions derived from 4D MRI. Blood flow helicity and wall shear stress descriptors were assessed. A bulge inflation test was carried out in vitro on the 4 ATAAs after surgical repair. The healthy volunteers showed no eccentric blood flow, a mean TAWSS of 1.5±0.3 Pa and mean OSI of 0.325±0.025. In 3 aneurismal patients, jet flow impingement on the aortic wall resulted in large TAWSS values and low OSI which were amplified by the AI degree. However, the tissue strength did not appear to be significantly reduced. The fourth patient, which showed the lowest TAWSS due to the absence of jet flow, had the smallest strength in vitro. Interestingly this patient presented a bovine arch abnormality. Jet flow impingement with high WSS values is frequent in ATAAs and our methodology seems to be appropriate for determining whether it may increase the risk of rupture or not.

Chronic periaortitis (CP) is usually referred to as a spectrum of rare diseases characterized by the presence of an aberrant fibroinflammatory tissue usually located around the infrarenal portion of the abdominal aorta and around the iliac arteries [1]. A recent study showed that in approximately one third of cases CP may also involve other vascular districts, particularly the thoracic aorta and its major branches, which reinforces the view that CP may be a systemic fibroinflammatory disease [2].

Thoracic endovascular aortic repair (TEVAR) is an emerging treatment option for thoracic aorta aneurysms (TAA). Endovascular access is a challenge. We present a novel TEVAR technique in a patient with single kidney and a 6.4 cm TAA. Attempting to place a sheath through iliac arteries was unsuccessful. The decision to proceed to hybrid TEVAR was made. The protection of the solitary kidney was achieved through axillo-femoral bypass, followed by an end-to-side anastomosis between the aorta and a bifurcated graft. Through the graft, a stent was introduced in the thoracic aorta. With the use of contrast material, the right position of the graft was confirmed.

Many years following transplantation, heart transplant recipients may require noncardiac major surgeries. Anesthesia in such patients may be challenging due to physiological and pharmacological problems regarding allograft denervation and difficult immunosuppressive management. Massive hemorrhage, hypoperfusion, renal, respiratory failure, and infections are some of the most frequent complications related to thoracic aorta aneurysm repair. Understanding how to optimize hemodynamic and infectious risks may have a substantial impact on the outcome. This case report aims at discussing risk stratification and anesthetic management of a 54-year-old heart transplant female recipient, affected by Marfan syndrome, undergoing thoracic aorta aneurysm repair.

The precise pathogenesis of the ascending aortic aneurysm (AscAA) remains to be determined. Mast cells in the adventitia of human AscAA lesions may play a role in this pathogenesis. Adventitial mast cell density per 10 high-power fields (0.25 mm2) was assessed in multiple biopsy samples, from aneurysmal aortic sections (n = 41) and control (nondilated) aortic specimens (n = 50), stained by orcein-Giemsa method, an inexpensive (

We present a 66-year-old man with a 5.7-cm saccular descending thoracic aortic aneurysm and a smaller 4.6-cm aneurysm just proximal to the celiac artery. The patient was judged to be too risky for open surgical repair because of poor anatomy and health. Previous stenting of the iliac arteries for a kinked aortoiliac open graft precluded conventional endovascular aneurysm repair. The descending thoracic aorta was successfully repaired using endovascular methods with a standard Talent (Medtronic, Los Angeles, Calif) thoracic proximal main stent graft, which was reverse-loaded onto the delivery device and delivered antegrade through the right axillary artery.

Thoracic aortic aneurysms (TAA) are rarely symptomatic. A 55 year old male presents with longstanding chronic backache. CXR showed left hilar shadow with collapse of left lung. Considering the CXR findings and with the patient being chronic smoker a strong possibility of carcinoma lung with bony metastasis was kept and further CECT chest was done. The CECT chest was suggestive of a thoracic aorta aneurysm with thrombosis compressing left principal bronchus and its lower lobar branch resulting in distal area of collapse and consolidation of left lower lobe. These findings were further confirmed on CT angiography. The patient was thus diagnosed as a case of descending thoracic aorta aneurysm probably of atherosclerotic etiology with thrombosis. Patient was started on beta blockers and ACE inhibitors along with supportive and symptomatic treatment and was further transferred to the department of CTVS for surgical intervention. Thus, this case report here signifies that possibility of thoracic aorta aneurysm should always be considered in a patient with chronic backache specially in presence of mediastinal shadow on CXR.

Ischemic spinal cord injury is a chain of events caused by the reduction and/or cessation of spinal cord blood flow, which results in neuronal degeneration and loss. Ischemic postconditioning is defined as a series of intermittent interruptions of blood flow in the early phase of reperfusion and has been shown to reduce the infarct size in cerebral ischemia. Our study aimed to characterize the relationship between the neuronal injury-decreasing effects of citicoline and ischemic postconditioning, which were proven to be effective against the apoptotic process. Spinal cord ischemia was produced in rats using an intrathoracic approach to implement the synchronous arcus aorta and subclavian artery clipping method. In our study, 42 male Sprague-Dawley rats (309 +/- 27 g) were used. Animals were divided into sham operated, spinal ischemia, citicoline, postconditioning, and postconditioning citicoline groups. Postconditioning was generated by six cycles of 1 min occlusion/5 min reperfusion. A 600 mmol/kg dose of citicoline was given intraperitoneally before ischemia in the citicoline and postconditioning citicoline groups. All rats were sacrificed 96 h after reperfusion. For immunohistochemical analysis, bcl-2, caspase 3, caspase 9, and bax immune staining were performed. Caspase 3, caspase 9, bax, and bcl-2 were used as apoptotic and antiapoptotic markers, respectively. The blood pressure values obtained at the onset of reperfusion were significantly lower than the preischemic values. A difference in immunohistochemical scoring was detected between the caspase 3, caspase 9, bax, and bcl-2 groups. When comparisons between the ischemia (groups 2, 3, 4, and 5) and sham groups (group 1) were performed, a significant increase in caspase 3, caspase 9, bax, and bcl-2 was detected. When comparing the subgroups, the average score of caspase 9 was found to be significantly higher in ischemia group 2. The average score of bcl-2 was also found to be significantly higher in postconditioning and citicoline group 5. It is thus thought that combining citicoline with postconditioning provides protection by inhibiting the caspase pathway and by increasing the antiapoptotic proteins.

Degradation of the wall of human ascending thoracic aorta has been assessed through Optical Coherence Tomography (OCT). OCT images of the media layer of the aortic wall exhibit micro-structure degradation in case of diseased aortas from aneurysmal vessels or in aortas prone to aortic dissections. The degeneration in vessel walls appears as low-reflectivity areas due to the invasive appearance of acidic polysaccharides and mucopolysaccharides within a typical ordered microstructure of parallel lamellae of smooth muscle cells, elastin and collagen fibers. An OCT indicator of wall degradation can be generated upon the spatial quantification of the extension of degraded areas in a similar way as conventional histopathology. This proposed OCT marker offers a real-time clinical insight of the vessel status to help cardiovascular surgeons in vessel repair interventions. However, the delineation of degraded areas on the B-scan image from OCT is sometimes difficult due to presence of speckle noise, variable SNR conditions on the measurement process, etc. Degraded areas could be outlined by basic thresholding techniques taking advantage of disorders evidences in B-scan images, but this delineation is not always optimum and requires complex additional processing stages. This work proposes an optimized delineation of degraded spots in vessel walls, robust to noisy environments, based on the analysis of the second order variation of image intensity of backreflection to determine the type of local structure. Results improve the delineation of wall anomalies providing a deeper physiological perception of the vessel wall conditions. Achievements could be also transferred to other clinical scenarios: carotid arteries, aorto-iliac or ilio-femoral sections, intracranial, etc. This work has been supported by the Spanish Government through the CYCIT projects DA2TOI (FIS2010-19860) and FOS4 (TEC2013-47264-C2-1-R).

Introduction. Hybrid procedures represent staged or simultaneous endovascular and open surgical techniques in the treatment of complex pathologies of the thoracic and abdominal aorta. We are presenting a patient with previous abdominal aortic surgery in whom hybrid vascular procedure for descending aorta and left subclavian artery aneurysm was performed. Case Outline. A 63-year-old female patient was admitted for computed tomography angiography. Descending aorta aneurysm (7.6 cm) as well as aneurysm of the left subclavian artery (LSA) was noted. Eight years ago she underwent abdominal aortic aneurysm resection and aortoiliac bypass. Standard TEVAR (thoracic endovascular aortic repair) procedure couldn’t be done due to small dimensions of previous “Y” graft (12.6 mm), so first we did LSA transposition and after three days hybrid procedure. After “Y” graft exposure, anastomosis between the corps of “Y” graft and tubular graft 10 mm was created and through this conduit thoracic stent-graft was placed followed by complete “Y” graft replacement. After 6 months angiography showed regular postoperative findings. Conclusion. Combined surgical and endovascular procedures in thoracic aorta pathology treatment could be useful solutions with favorable outcome. [Projekat Ministarstva nauke Republike Srbije, br. 41002]

Objective: It is controversial whether microorganisms play a role in the pathogenesis of large and medium vessel vasculitides (eg, giant cell arteritis [GCA], Takayasu arteritis [TAK] and focal idiopathic aortitis [FIA]). Recent studies have reported the presence of Varicella Zoster Virus (VZV) within formalin-fixed, paraffin-embedded temporal arteries and aortas of about three-quarters or more of patients with these conditions, and in a minority of controls. In a prospective study, we sought to confirm these findings using DNA extracted from vessels that were harvested under surgically aseptic conditions and snap frozen.Methods and Results: DNA samples extracted from 11 surgically sterile temporal arteries and 31 surgically sterile thoracic aortas were used in an attempt to identify the vessel-associated VZV genome. Two different validated PCR methods were used. Thirty-one thoracic aorta aneurysm specimens included biopsies from 8 patients with GCA, 2 from patients with TAK, 6 from patients with FIA, and 15 from patients without vasculitis, who had non-inflammatory aneurysms. Eleven temporal artery biopsies were collected from 5 patients with GCA and 6 controls. The presence of VZV was not identified in either the specimens from patients with large vessel vasculitis or from the controls.Conclusions: Using surgically sterile snap-frozen specimens, we were unable to confirm recent reports of the presence of VZV in either aortas or temporal arteries from patients with large vessel vasculitis or controls.Keywords: Aorta and temporal artery biopsies, Varicella Zoster Virus, Large Vessel Vasculitis

Methods A 61 years old man with abdominal endovascular aortic stent-graft inserted previously, had a saccular aneursym of descending aorta distal to left subclavian artery and a small dissection flap with saccular aneursym originating from left subclavian artery. Since the patient refused to have any surgical procedure for left subclavian artery revascularisation, thoracic aortic-stenting for descending aorta just below the subclavian origin and a second stent-graft for left subclavian artery just above the orifice was planned. Coverage of left subclavian artery was not preferred aiming to avoid possible cerebrovascular events. During intervention, stent-graft to be inserted inside subclavian artery migrated totally into aortic arch in a perpendicular fashion.

Anatomske posebnosti izvora, poteka, vej in medsebojnih anastomoz enajstih parov zadnjih medrebrnih arterij (AIP) imajo velik praktični pomen na različnih področjih medicine, od diagnostičnih metod do kirurgije, zaradi obsežne direktne ali indirektne preskrbe medrebrnih prostorov (SIC), mišic, hrbtenjače, kože in mlečne žleze. Z anatomsko disekcijo smo pri 43 človeških kadavrih fiksiranih s Thielovo metodo, ki so imeli z rdečo barvo injicirane arterije, določili nove anatomske posebnosti izvora, poteka in vej AIP. Ugotoviti smo želeli povezavo med pojavom novih anatomskih posebnosti, njihovimi frekvencami in razlikami med levimi in desnimi AIP v populaciji in pri posamezniku ter kliničnim pomenom le-teh. Rezultati raziskave so pokazali, da obstajajo nove posebnosti izvora, poteka in vej AIP. V raziskavi so bile glede na izvor iz podključnične arterije (AS) in prsne aorte (AT) najbolj variabilne AIP I. - III., njihovi izvori pri posamezniku pa so bili največkrat bilateralno simetrični. Dorzalno za rebri potekajočo AIP, ki jo imenujemo prsna vertebralna arterija (AVT), smo našli pri AIP IV. in AIP V., posamezen osebek pa je imel lahko več AVT. Posebnosti poteka AIP so pomembne pri določitvi in prepoznavi arterij v diagnostične namene, ker se lahko njihovo najdbo zaradi nenormalnega poteka narobe interpretira, obenem pa so posebnosti poteka pomembne pri patoloških stanjih, ki zahtevajo kirurško oskrbo, kot so ateroskleroza, elongacija aorte, fraktura hrbtenice in reber. Od vseh najdenih variacij smo v raziskavi največkrat našli skupna debla, ki so jih sosednje AIP oblikovale na izvoru iz AT, med katerimi je bil pogost pojav multiplih skupnih debel. Na račun multiplih skupnih debel se zmanjša število segmentalnih aortnih AIP, ki oddajo veje za preskrbo hrbtenjače, s čimer se potencialno poveča tveganje za pojav pooperativne paraplegije ali parapareze, ker se arterije pri operacijah anevrizem na torakalni ali torakoabdominalni aorti podveže. V raziskavi smo določili število kolateralnih medrebrnih vej AIP in njihovih anastomoz in ugotovili, da med medrebrnimi prostori (SIC) IV. - XI. ni takega, ki bi bil za izvedbo torakocenteze varnejši od drugih. V raziskavi smo določili posebnosti izvora desne bronhialne arterije (AB), ki je največkrat izvirala iz prve desne aortne AIP, izvor pa je variiral od skupnega debla AIP I. - III. iz AS ter AIP II. do AIP V. iz AT. Vloga posebnosti izvora desne AB je pomembna v terapiji karcinomov pljuč, saj se preko arterije aplicira kemoterapevtska sredstva. S stališča anatomskih posebnosti AIP in njihove pomembnosti v klinični praksi, še posebej, če je hkrati prisotno več raznolikih posebnosti ali se le-te pojavljajo v večjem številu, je njihov opis v klasičnih anatomskih knjigah omejen. Zaradi razvoja moderne torakalne kirurgije, posebno srčno-žilne, predstavljajo podatki dobljeni z raziskavo osnovo za natančno opredelitev anatomskih posebnostih AIP in njihovega pomena v klinični praksi. Anatomical peculiarities of the origin, course, branches and anastomoses of the eleven paired posterior intercostal arteries (AIP) have practical significance in different fields of medicine, from diagnostic methods to surgery, because of extensive direct and indirect vascularization of the intercostal spaces (SIC), muscles, spinal cord, skin and mammary gland. During anatomical dissection of 43 human cadavers fixed using the embalming method of Thiel, with injected arteries with red color mass, we found new anatomical variations of the origin, course and branches of the AIP. Aim of the study was to evaluate linkage between occurrences of new anatomical variations, their frequencies and differences among left and right AIP in population and individuals and discus their clinical significance. The study revealed new variations of the origin, course and branches of the AIP. The most variable origins from the subclavian artery (AS) or thoracic aorta (AT) were origins of AIP I. - III., the patterns of origins being mostly bilateral symmetrical in individuals. Dorsal course of the AIP known as thoracic vertebral artery (AVT) was found at AIP IV. and AIP V., in some individuals more of AVT were present. Peculiarities of the course of AIP are important in determination and identification of the arteries for diagnostic purposes, because finding of unusual course can be misinterpreted, and also in pathological conditions which need surgical treatment such as atherosclerosis, elongation of the aorta and fracture of the spine and ribs. Common trunks of the AIP at the origin from AT formed by neighboring arteries were the most frequent among all anatomical variations and numerous of multiple common trunks were simultaneously present. Multiple common trunks reduce the overall number of segmental aortic AIP which give off branches for the vascularisation of the spinal cord and potentially increase the risk of postoperative paraplegia or paraparesis in patients undergoing thoracic or thoracoabdominal aortic aneurysm repair when vessels are being ligated. Study determined that regarding the number of the collateral branches of the AIP and their anastomoses there is not any intercostal space (SIC) between IV. - XI. that is as safe as others in performing thoracocentesis. Study of anatomical peculiarities of the origin of right bronchial artery (AB) recorded that most of the arteries originated from the first aortic AIP, the origins varied from common trunk of the AIP I. - III. from AS to AIP II. - V. from AT. The role of variations of AB origin is important in lung cancer therapy because the arteries serve as therapeutic pathways for infusion of chemotherapeutic agents. Regarding the anatomical peculiarities of AIP and their significance in clinical practice, especially if different peculiarities are present at once or if they often occur in one individual, description in classic anatomical books is limited. In the era of modern thoracic surgery, particularly cardiovascular, the data of the anatomical peculiarities of the AIP and their significance in clinical practice from the study represent basis for their detailed recognition and clinical evaluation.

The study focuses on modern approaches to diagnostics and surgical treatment of patients with aneurysms of the thoracic aorta combined with congenital pathologies of the aortic arch and brachiocephalic arteries. The effect of hypothermia, extracorporeal blood circulation, cerebral perfusion, preventive transposition of the aberrant subclavian arteries is evaluated in the context of prevention of postoperative complications. 34 patients with aneurysms of the thoracic aorta were included in the study. Aortic aneurysms were found in 22 of patients with congenital aortic arch defects and in 12 patients with an abnormal position of the arch and/or brachiocephalic arteries. Aberrant origin of the subclavian arteries is the most common defect of the arch in the case of thoracic aorta aneurysms. Aortic arch kinking and congenital anomalies of the aortic arch significantly influence the tactic of surgical treatment of aneurysms because of a high probability of clamping the aortic arch branches and neurological complications. Therefore, prevention of cerebral complications is the primary objective of surgery. Cerebral perfusion or staged surgical interventions also find extensive use. A congenital aortic arch in a number of patients determines a surgical approach and influences the choice of techniques. Surgical treatment of aortic aneurysms associated with congenital anomalies or kinking of the aortic arch depends on a set of several factors. The surgical decision must be based on precise preoperative diagnosis and detailed analysis of all individual anatomical characteristics of the aortic arch and its branches. The safety and efficacy of operations can only be achieved on the basis of a differentiated and individual approach.Received 6 October 2016. Accepted 11 December 2016.Funding: The study had no sponsorship.Conflict of interest: The authors declare no conflict of interest.Author contributionsAll authors meet ICMJE authorship criteria and contributed equally at all stages of the research.

Myofibroblasts (MFs) are contractile cells deriving from a multiplicity of resident cells and/or circulating progenitors that are known to play a key role in wound healing. They were first discovered and analysed in the early 1970s in granulation tissue. Since their first identification, the role of MF and their mechanisms of differentiation have been highlighted in a number of diseases, including organ fibrosis and tumours, with particular attention devoted to the liver, kidney, and pulmonary fibrosis. The aim of this review is to summarize the current evidence for the role played by MFs in two frequent vascular diseases related to the remodelling of the vascular wall: the different forms of arterial restenosis and the most common forms of thoracic aortic aneurysm. The in-depth knowledge of the molecular pathways involved in MF differentiation, contraction, and survival/apoptosis could contribute to the identification of novel therapeutic strategies for anti-fibrotic and anti-remodelling therapy of vascular diseases in which these cells are involved.

Background: Endovascular repair of the thoracic aorta has shown reduced morbidity and mortality compared with open surgery. We describe our experience with endovascular stent grafting in the treatment of acute thoracic aortic pathology. Methods: From October 2003 to January 2008, 25 patients underwent endovascular stent graft repair of the thoracic aorta. The underlying pathology was a complicated Stanford type B dissection (n = 13), a symptomatic or ruptured thoracic aorta aneurysm (n = 6), a symptomatic penetrating atherosclerotic ulcer (n = 5), or a traumatic aortic injury (n = 1). There were 21 males and four female patients with a mean age of 61.3 years (30–91 years). Routine surveillance included clinical evaluation and contrast-enhanced spiral computed tomography scans before discharge and at 3, 6, and 12 months after the procedure and yearly thereafter. Results: Stent graft placement was technically successful in all patients. There was no intraoperative mortality. Hospital mortality was of two patients (8%). Paraparesis occurred in one patient (4%). Average intensive care unit and hospital stay was 1 and 10 days, respectively. The mean follow-up was 30 months (range, 7–53). Late mortality was in one patient (4%), due to a type A dissection. During the follow-up, four patients (16%) required a second procedure for type I endoleak. Conclusions: Mortality and morbidity in our small series were low. Close follow-up is mandatory and long-term results have to be awaited.

Open-heart surgery during pregnancy is challenging because it requires attention to both mother and fetus. A 31-year-old pregnant woman underwent surgery for a large ascending aorta aneurysm threatening rupture in the 12th week and then went on to a cesarean section at 38 weeks, which produced a healthy baby.

Despite recent improvements in surgical techniques and patient care, open surgery for degenerative aneurysms in the thoracic aorta is still associated with major morbidity in the form of death, cardiac, renal and neurological complications. Recent clinical experience indicates that most of thoracic aortic pathology is potentially amenable to minimally invasive therapy with endovascular stent graft repair. Single-center series as well as the first comparative studies in the form of case-control comparisons demonstrate that endovascular treatment offers an early postoperative outcome more favorable than open surgery. Hybrid procedures, which combine an open surgical step for branch vessel rerouting to create a stent-graft seal zone where none existed, have been applied increasingly to afford a stent-graft option in patients with lesions involving the aortic arch or visceral aorta. Endograft technology is still in evolution. Future refinements will address some of the most important needs like lower profile delivery systems, greater device flexibility, precise deliverability and deployment characteristics that will contribute to achieve optimal success and safety, especially in the region of the aortic arch. Endovascular treatment of complex thoraco-abdominal aneurysms and arch aneurysms with fenestrated or branched endografts has recently been introduced in the clinical setting in small series in few centers with a focused expertise. Preliminary results are promising but the more widespread use of this technology should not occur until longer-term results will become available.

Item does not contain fulltext BACKGROUND: To describe the transapical approach for thoracic endovascular aortic repair (TEVAR). METHODS: Three patients, 2 elective and 1 emergent, with thoracic aorta aneurysm are described with vascular or direct aortic inaccessible access, who underwent TEVAR through transapical access. The technique is described in detail emphasizing the usefulness of the through-and-through guidewire, rapid pacing, and transesophageal echocardiography guidance. RESULTS: All patients were technical successfully treated with TEVAR through transapical access. The emergent patient, however, died due to multiorgan failure. CONCLUSIONS: Our early experience shows that the transapical approach for TEVAR procedures is feasible in experienced hands. The selection of the patient and careful planning based on imaging are of paramount importance and should lead to the most suitable access site tailored to the need of the individual patient. 01 februari 2015

Background: Glutamergic excitotoxicity has been shown to play a deleterious role in the pathophysiology of ischemic spinal cord injury (ISCI). The aim of this study was to investigate the neuroprotective effect of a single dose of MK-801, an antiexcitotoxic drug, in a rat model of ISCI. Methods: Ischemic spinal cord injury was induced for 17 minutes in Sprague-Dawley rats using direct aortic arch, just proximal to the left common carotid artery, plus left subclavian artery cross-clamping through a left-sided limited thoracotomy. Study groups were as follows: control group (n = 8) receiving only vehicle and experimental group (n = 8) receiving a single dose of MK-801 (1 mg/kg IV) 10 minutes before aortic clamping. Neurological examination was performed at 6 hours, 24 hours, and daily up to 96 hours. Rats were sacrificed at 96 hours, and spinal cords were removed for histopathology. Results: All the control rats had severe permanent neurological deficits after ISCI, whereas the MK-801-treated rats had statistically (P

Thoracic aortic aneurysm with fistulization into the trachea or the esophagus is usually a lethal complication. An unusual case of combined aortotracheal and aortoesophageal fistulae is presented here. The patient had a successful outcome after resection of the aneurysm with tracheal repair and esophageal resection. A review of literature on this subject is also included in this manuscript.

We report on a 61-years-old male patient, who had an extensive arch and descending thoracic aorta aneurysm diagnosed while treating a pulmonary infection. The objective of this work is to report an unusual single stage surgical approach to correct an extensive arch and descending thoracic aorta aneurysm.

An 80-year-old man with a large (6 cm) aneurysm of the descending thoracic aorta was treated with a stent-graft endovascular implant in December 2002. A few days later, he presented with fever of unknown origin that continued for 12 months despite extensive diagnostic investigation and several cycles of empiric antibiotic therapy. In July 2003 he was admitted to the hospital because of fever and worsening of his general condition. Examination showed the man was febrile (38°C) and dyspnoeic, with a left scrotal mass. Laboratory investigations showed a white blood cell count of 6·0 10/L with a normal differential, an ESR of 45 mm/h, and mild renal and liver impairment. Blood culture was negative, as were other extensive laboratory tests. The left testis was removed and histological examination revealed the presence of chronic granulomas. A chest computerised tomography (CT) scan confirmed a perigraft endoleak as the cause of the increase in size of the aneurysmal sac (10·5 cm), and the patient was scheduled for a proximal stent-graft extension placement in September 2003. A multislice CT done 7 days after intervention showed total exclusion of the perigraft endoleak but the large aneurysmal sac imprinted and dislocated the oesophagus (figure, A, arrow). After further investigation, Mycobacterium tuberculosis was isolated from blood, urine, and stool specimens. The testis was examined for M tuberculosis and tested positive with the Gen-Probe Amplified M tuberculosis direct test and the BDProbetecET system for M tuberculosis complex. Scanning with Tc-labelled autologous leucocytes showed substantial perigraft accumulation. 2 months later, a CT scan showed an air bubble inside the aneurysmal sac, partly emptied into an aortooesophageal fistula (figure, B, arrow). The patient died at home in December 2003. Although tuberculosis infection of vascular implants is supposed to be very uncommon, it should be considered in elderly patients with fever of unknown origin. Lancet Infect Dis 2005; 5: 251

The authors describe a Salmonella typhimurium infection of thoracic aorta aneurysm in an immunocompetent subject. The patient, a 62-year-old male, was found to have recurrent S. typhimurium bacteremia despite multiple antibiotic treatments. A roentgenogram of the chest, which was normal on admission, revealed the presence of a first arch enlargement of the heart shadow. A computed tomography confirmed the diagnosis. Surgical resection of the aneurysm was carried out with in situ prosthetic graft interposition. The surgical specimen culture yielded S. typhimurium. The postoperative course was uneventful. Twenty-four months after discharge the patient remained well. A review of English language literature is presented.