Tenezaca-Sari Angel Xavier, Gil-Sala Daniel, Escolà-Vergé Laura, Lung Mayli, González-López Juan José, Bellmunt-Montoya Sergi
Angiology, Vascular and Endovascular Surgery Department, Hospital Universitari Vall d'Hebron, Barcelona, Spain..
Angiology, Vascular and Endovascular Surgery Department, Hospital Universitari Vall d'Hebron, Barcelona, Spain.
Ann Vasc Surg. 2022 Jan;78:379.e7-379.e10. doi: 10.1016/j.avsg.2021.06.031. Epub 2021 Sep 3.
The aim of this article is to present a case of mycotic aneurysm of internal carotid artery secondary to livestock-associated methicillin-resistant Staphylococcus aureus (LA-MRSA) treated with resection and common-to-internal carotid artery bypass with autologous vein graft in a male pig farmer. A 69-year-old man, pig farmer, with recent dental extraction was admitted with a right cervical pulsatile mass, dysphonia, pain, leukocytosis and elevated C-reactive protein (CRP). Ultrasonography (US) and computed tomography angiography (CTA) showed a 3.9 × 4.5 cm mycotic aneurysm of right internal carotid artery with hypermetabolic uptake in positron emission tomography (PET) scan. Resection of the mycotic aneurysm and a common-to-internal carotid artery bypass with major saphenous vein graft were performed. LA-MRSA clonal complex (CC) 398 was detected in intraoperative samples and antibiotic therapy was changed according to antibiogram. Patient was discharged at the seventh postoperative day and received antibiotic therapy for 6 weeks. US 12 months later showed patency of the bypass without collections. Mycotic aneurysms of internal carotid artery are very infrequent. MRSA isolation is rare, and to the best of our knowledge this is the first case caused by multi-drug resistant LA-MRSA CC398. The treatment includes mycotic aneurysm resection and reconstruction with venous graft bypass plus intensive antibiotic therapy.
本文旨在介绍一名男性养猪户因感染与家畜相关的耐甲氧西林金黄色葡萄球菌（LA-MRSA）继发颈内动脉霉菌性动脉瘤，接受切除及自体静脉移植行颈总动脉至颈内动脉搭桥术的病例。一名69岁的男性养猪户，近期拔过牙，因右侧颈部搏动性肿块、声音嘶哑、疼痛、白细胞增多及C反应蛋白（CRP）升高入院。超声检查（US）和计算机断层血管造影（CTA）显示右侧颈内动脉有一个3.9×4.5厘米的霉菌性动脉瘤，正电子发射断层扫描（PET）显示有高代谢摄取。进行了霉菌性动脉瘤切除及大隐静脉移植行颈总动脉至颈内动脉搭桥术。术中样本检测到LA-MRSA克隆复合体（CC）398，并根据药敏试验结果调整了抗生素治疗方案。患者术后第7天出院，接受了6周的抗生素治疗。12个月后的超声检查显示搭桥血管通畅，无积液。颈内动脉霉菌性动脉瘤非常罕见。分离出MRSA的情况很少见，据我们所知，这是首例由多重耐药的LA-MRSA CC398引起的病例。治疗方法包括霉菌性动脉瘤切除、静脉移植搭桥重建以及强化抗生素治疗。
