CASE REPORT   

Chirurgia 2020 June;33(3):170-3

DOI: 10.23736/S0394-9508.19.04999-4

Copyright © 2019 EDIZIONI MINERVA MEDICA

language: English

Endovascular treatment of a descending thoracic aortic aneurysm secondary to Listeria Monocytogenes

Liliana FIDALGO DOMINGOS ¹ ✉, Miguel MARTIN PEDROSA ¹, Ruth FUENTE GARRIDO ², Álvaro REVILLA CALAVIA ¹, Carlos VAQUERO PUERTA ¹

¹ Department of Angiology and Vascular Surgery, University Hospital of Valladolid, Valladolid, Spain; ² Department of Angiology and Vascular Surgery, University Hospital of Burgos, Burgos, Spain

The management of mycotic aneurysms of the descending thoracic aorta remains a challenge for the vascular surgeon and the prognosis after the surgery is poor with a high mortality rate. We report the first case of a Listeria monocytogenes mycotic aneurysm of the descending thoracic aorta managed with an endovascular technique and chronic antibiotic therapy. An 83-years-old male patient presented with a febrile syndrome and positive blood cultures for Listeria monocytogenes. A computed tomography angiography showed three levels of saccular dilatations in the descending aorta, distally to the emergence of the left subclavian artery. Given the deterioration of the patient’s condition and his previous medical history, conventional open surgery was discarded and an endovascular approach was chosen. A thoracic endograft impregnated with rifampicin was deployed from below the left subclavian artery ostium to the origin of the celiac artery, covering the three levels of saccular dilatations The endograft’s impregnation with rifampicin was performed by the surgeon at the back table, prior to the implantation, by flushing a rifampicin solution through both flush ports of the device. A final angiogram showed an adequate exclusion of the mycotic aneurysm with no endoleak sign and patency of left subclavian artery and celiac trunk. Our experience suggests that the endovascular treatment of thoracic mycotic aneurysms caused by Listeria monocytogenes with a rifampicin impregnated endograft associated to chronic antibiotic treatment, is a feasible and safe alternative in high-risk patients, with acceptable mid-term results. Early results in this field are encouraging, but further investigation is needed.

KEY WORDS: Listeria monocytogenes; Aneurysm, infected; Aortic aneurysm, thoracic; Endovascular procedures