Endovascular Treatment Of Infected Aortic Aneurysms Involving … · ahmed sayed, hisham bassiouny...
Transcript of Endovascular Treatment Of Infected Aortic Aneurysms Involving … · ahmed sayed, hisham bassiouny...
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Endovascular Treatment Of Infected Aortic Aneurysms Involving The Visceral Vessels: Case Discussion
AHMED SAYED, HISHAM BASSIOUNY
KASR ALAINY HOSPITAL, CAIRO UNIVERSITY, EGYPT
DAR ALFOUAD HOSPITAL, CAIRO, EGYPT
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Disclosure
Speaker name:
Ahmed Sayed
I do not have any potential conflict of interest
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Case Presentation:63 yr old male presented with acute myeloid leukemia, & Atrial fibrillation
• Chemotherapy
• Bone marrow transplantation
• Immuno-suppression
• Acute right hypochondrial pain and tenderness
• Initial U/S and CT of the abdomen were unremarkable
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CTA 5 DAYS LATER
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• Renal functions: normal
• Renal scintigraphy : marked decline of function in the right kidney
• Negative blood culture
• Antimicrobial therapy:
– Meronam, Vancomycin, and Caspofungin
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Management Options• Delayed repair after control of infection?
• Immediate Repair?
Open Repair
Debridement – durable
++ Morbidity and mortality Durability? No debridement
Less Morbidity and mortality
Endovascular repair
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Limitations Of Open Surgery
• Thoraco-abdominal exposure
• Aortic cross-clamping (supraceliac)
• Unpredictable extent of aortic wall infection
• Difficult closure of aortic stump in case ofextra-anatomic bypass
• Extremely high-risk patient for suchhemodynamic stress and ischemia-reperfusion injury
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Management Options
B) Endovascular repair
1. Fenestrated graft
2. Chimney/snorkel
3. Debranching
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Debranching followed by EVAR in the same session
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Post-deployment type 1 endoleak
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Balloon dilatation
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Final angiogram
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Postoperative course
Uneventful recovery
3 Days later: rise of creatinine to 4mg/dL , but urine output was 50-150 ml/hour
Return to normal renal functions and urine output after two weeks
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Postoperative Course
• Bone marrow depression :
– persistent anemia (Hb:8g/dL) inspite of blood transfusion
– TLC : 850/mm3
– Platelets: dropped gradually to 15000/mm3
• The patient developed circulatory collapse, no postmortem was available.
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Complete resolution of infection by antibiotics
Ann Vasc Surg 2016; 33: 228.e1–228.e4
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J Vasc Surg. 2016 Sep;64(3):803-6
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Sörelius et al,
Circulation 2014;130:2136-2142
130 infected aneurysms
16 centers
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Main findings
1. Good short-term outcome(91% survival at 30 days)
2. A significant number (19%) of fatal infection-related complications
3. A relatively good long-term outcome(55% survival at 5-years)
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• A palliative treatment option
• A bridge to later elective radical open surgery, once the patient has recovered from the initial emergency.
However, this strategy was rarely adopted. A few were
converted to emergency open repair for life-threateningcomplications, whereas most patients were either toowell to justify a major open procedure or were too fragileto withstand such an operation.
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Summary
• Infected aortic aneurysms can progress andrupture quite rapidly
• Endovascular exclusion with debranching ofthe visceral vessels is a suitable option in suchhigh risk patients.
• Less invasive than open surgery.
• A bridge to open surgery or a destinationtherapy.
• The extent of aortic coverage is debatable
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Thank you for your attention!
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Endovascular Treatment Of Infected Aortic Aneurysms Involving The Visceral Vessels: Case Discussion
AHMED SAYED, HISHAM BASSIOUNY
KASR ALAINY HOSPITAL, CAIRO UNIVERSITY, EGYPT
DAR ALFOUAD HOSPITAL, CAIRO, EGYPT