Endovascular Treatment for Tuberculous Mycotic Aneurysm …...Introduction •Nowadays, EVAR is new...
Transcript of Endovascular Treatment for Tuberculous Mycotic Aneurysm …...Introduction •Nowadays, EVAR is new...
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Endovascular Treatment for
Tuberculous Mycotic
Aneurysm at Aortic bifurcation 15 March 2017
Apinan Uthaipaisanwong M.D.
Department of Surgery
King Chulalongkorn Memorial Hospital
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Disclosure
Speaker name:
Apinan Uthaipaisanwong MD.
I have the following potential conflicts of interest to report:
Consulting
Employment in industry
Stockholder of a healthcare company
Owner of a healthcare company
Other(s)
I do not have any potential conflict of interest
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Introduction
•Nowadays, EVAR is new trend for treatment
mycotic aortic aneurysm.
•Almost of cases were bacterial cause.
•Mycobacterium tuberculosis is a rare cause of
mycotic aneurysms.
•This study report the outcome of endovascular
treatment of Tuberculous mycotic aneurysm
combined Antituberculosis drug.
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Case Presentation
A 70 year-old male presented with severe
back pain and prolonged fever for 3 months.
Underlying Disease
•Essential Hypertension
•Dyslipidemia
•Fully recovered stroke
Physical Examination
•Fever
•No other significant findings
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Investigation
•Mild leukocytosis
•Microscopic hematuria
•Elevated ESR 88 (0-15)
CPR 96 (0-5)
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X-ray
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CT Scan
Urine PCR for TB was positive.
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Planning for treatment
•Antituberculosis regimens
•Regimen Isoniazid Rifampicin
Ethambutol Pyrazinamide
•Bifurcated EVAR
•Double J stent Lt kidney
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Planing for EVAR
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Left Internal Iliac Artery Emboliation
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Planing for EVAR
20% Over sizing
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Postoperative Peroid
•Final Aortogram
•No endoleak
•No immediate complication
•Stay one night in ICU
•Back pain was significantly improved.
•Discharge in 1 week later
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Post EVAR 1 week
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CT scan follow up
3 months 6 months
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Conclusion
•Tuberculous mycotic aneurysm can be
successfully treated by combined
antituberculosis drug with endovascular
treatment.
•Short term outcome was effective.
However, long term follow up was
needed.
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Acknowledgement
•Assoc. Prof. Kritaya Kritayakirana M.D.
•Dr. Pawanrat Kranokpiraksa M.D.
•Dr.Nantisakarn Chanpen M.D.
•Dr.Nattawut Narueponjirakul M.D.
•Dr.Punthita Aimsupanimitr M.D.
•Dr.Sirinya Panya M.D.
King Chulalongkorn Memorial Hospital,
Chulalongkorn University, Bangkok,
Thailand
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Thank You
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Endovascular therapy
For
Infected Aortic Aneurysm
In
King Chulalongkorn Memorial Hospital Experience
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Infected Aneurysm
•Number 12 cases (15%) from 82 cases
since 2012 – 2016
•Mean age was 68.6±13.7 year-old
•Male were 83%.
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Infected Aneurysm
Number (%)
Abdominal/Back pain 12 (100)
Fever 9 (75)
Diarrhea 1 (8.3)
Arthritis 1 (8.3)
Mean leukocyte counts 10352 ± 3388 per ul (5410-18450)
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Pathogen Identification
72%
14%
14%
Salmonella species
Staphylococcus
aureusMycobacterium
tuberculosis
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Mycotic Aneurysm
•Most mycotic aneurysms had saccular
morphology.
•Thirty-day mortality was 1 case (8.3%).
•No postoperative requirement of
explantation endovascular stent graft was
occurred.
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Thank You
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Endovascular Treatment for
Tuberculous Mycotic
Aneurysm at Aortic bifurcation 15 March 2017
Apinan Uthaipaisanwong M.D.
Department of Surgery
King Chulalongkorn Memorial Hospital