Chen Samuel L, Kuo Isabella J, Fujitani Roy M, Kabutey Nii-Kabu
Division of Vascular and Endovascular Surgery, Department of Surgery, University of California, Irvine Medical Center, Orange, CA.
Division of Vascular and Endovascular Surgery, Department of Surgery, University of California, Irvine Medical Center, Orange, CA.
Ann Vasc Surg. 2017 Jan;38:190.e1-190.e4. doi: 10.1016/j.avsg.2016.08.007. Epub 2016 Aug 20.
Acute aortic symptomatology is an unusual manifestation of Brucella melitensis infection. We present a rare case of acute multifocal thoracic and abdominal aortic ruptures arising from Brucellosis aortitis managed exclusively with endovascular surgery.
A 71-year-old Hispanic male with a history of atrial fibrillation and prior stroke on chronic anticoagulation presented with shortness of breath and malaise. In addition, he had been treated approximately 1 year previously in Mexico for B. melitensis bacteremia after eating fresh unpasteurized cheese. Computed tomography (CT) angiography demonstrated an acute rupture of the descending thoracic aorta just proximal to the celiac trunk and synchronous rupture at the abdominal aortic bifurctation.
The patient was taken emergently to the hybrid operating room, where synchronous supraceliac thoracic aorta and abdominal aortoiliac stent grafts were deployed under local anesthesia. Completion angiography demonstrated total exclusion of the thoracic and abdominal extravasation with no evidence of endoleak. Twenty hours postoperatively, the patient became acutely obtunded and hypotensive. Repeat CT angiography demonstrated contrast extravasation at the level of the excluded aortic bifurcation. Emergent angiography confirmed a type II endoleak with free extraluminal rupture. Multiple coils were placed at the level of the aortic bifurcation between the left limb of the stent graft and the aortic wall to tamponade the endoleak. No further extravasation was noted on final aortography. Postoperatively, blood cultures confirmed the diagnosis of B. melitensis. The patient was treated with systemic doxycycline, gentamicin, and rifampin. Resolution of the acute event occurred without additional sequelae and he was discharged from the hospital to a rehabilitation facility.
Concomitant multifocal aortic ruptures arising from Brucellosis aortic infection is a very rare event. In this case, the patient was successfully treated with thoracic and abdominal endovascular stent-graft exclusion, coiling, and long-term targeted antibiotics.
急性主动脉症状是羊布鲁氏菌感染的一种不寻常表现。我们报告一例罕见的因布鲁氏菌性主动脉炎导致急性多灶性胸主动脉和腹主动脉破裂，仅通过血管内手术治疗的病例。
一名71岁有房颤病史且曾因中风接受慢性抗凝治疗的西班牙裔男性，出现呼吸急促和全身不适。此外，他大约1年前在墨西哥因食用新鲜未杀菌奶酪后发生羊布鲁氏菌菌血症而接受治疗。计算机断层扫描（CT）血管造影显示，在腹腔干近端的降主动脉急性破裂，以及腹主动脉分叉处同步破裂。
患者被紧急送往杂交手术室，在局部麻醉下同步植入了腹腔干上方的胸主动脉和腹主动脉 - 髂动脉支架移植物。完成血管造影显示胸主动脉和腹主动脉外渗完全被排除，无内漏迹象。术后20小时，患者突然意识不清且血压降低。重复CT血管造影显示在被排除的主动脉分叉水平有造影剂外渗。紧急血管造影证实为II型内漏伴游离腔外破裂。在支架移植物左肢与主动脉壁之间的主动脉分叉处放置多个线圈以封堵内漏。最终主动脉造影未发现进一步外渗。术后，血培养确诊为羊布鲁氏菌感染。患者接受了多西环素、庆大霉素和利福平的全身治疗。急性事件得到解决，无其他后遗症，患者出院后前往康复机构。
布鲁氏菌性主动脉感染并发多灶性主动脉破裂是非常罕见的事件。在本病例中，患者通过胸主动脉和腹主动脉血管内支架移植物排除、线圈栓塞和长期针对性抗生素治疗获得成功。
