Endoluminal stenting of thoracic aorta mycotic aneurysms Free

We read with interest the paper by Kpodonu et al. in which they present their single case experience of 33-month follow up of a patient who had undergone endovascular stent graft management of a descending thoracic mycotic aneurysm [1]. We would like to congratulate the authors for their successful result in this controversial topic of vascular surgery despite their single case.

Endoluminal stent grafting is frequently applied to the aneurysms at critical segments of the aorta, such as thoracic and arch levels and can even be used for the treatment of mycotic aneurysms, with the increasing experience and refinements in the graft technology [2]. However, graft infection still accounts for one of the major risks in the follow up, although the procedure promises very good early results [1–4].

At our institution, two patients who were considered unsuitable for surgical treatment due to multiple comorbidity factors, had undergone endoluminal stent graft treatment of mycotic saccular aneurysms at the aortic arch. Unfortunately, one of the patients died 1 week postoperatively due to intracerebral bleeding. On the other hand, the second patient who was on chemotherapy for acute lymphoblastic leukemia, additionally had ankylosing spondilitis and chronic hepatitis B infection. He had also been uneventful in the early postoperative period [2] as well as for a postoperative period of 18 months until he presented with rupture of the descending aorta from the region at the end of the stent graft (Suppl. 1). He had undergone another successful stent graft implantation for the treatment of the aortic rupture (Suppl. 2) and was discharged to the hematology clinic with a life-long antibiotic regimen recommendation with co-trimoxazole. He had been followed asymptomatic for another 1-year period but died due to complications of acute lymphoblastic leukemia [4]. Parkinson et al. [3] in their recent paper presented a similar case with peripheral seeding of mycotic aneurysm from an infected aortic stent graft. Their patient had been asymptomatic for 3.5 years following initial treatment [3].

In conclusion, close monitoring of the patients who were treated for mycotic aneurysms with endoluminal measures is mandatory because they may frequently present with future aneurysms and ruptures at various segments of arterial tree. Additionally, since prophylactic life-long antibiotic treatment seems to be protective to a certain degree against future complications of mycotic aneurysms, in order to reach a consensus about postoperative treatment strategy it would be helpful to determine the best antibiotics if every author could present their experiences and recommendations about prescribed antibiotics for such cases.

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