The application of the drug flushing covered stent grafts in endovascular repair of aortic aneurysms caused by brucellosis.

OBJECTIVE

Brucellosis-induced aortic aneurysm (BIA), as a rare yet highly life-threatening type of infectious aortic aneurysm, currently lacks standardized treatment protocols. The primary objective of this study is to thoroughly evaluate the safety and efficacy of endovascular therapy using a combination of covered stents and drug irrigation techniques for the treatment of BIA. This endeavor aims to provide a scientific basis for the clinical management of this disease.

METHODS

This study employed a retrospective analysis approach to systematically collect comprehensive clinical data from patients with infectious aortic aneurysms admitted to three independent campuses of the same hospital from January 2016 to January 2024. The analysis encompassed a wide range of aspects, including patients' epidemiological characteristics, diverse clinical manifestations, detailed laboratory test reports, computed tomography angiography imaging data of the thoracoabdominal aorta(CTATA), specific treatment strategies, and prognosis during follow-up. The aim of this study is to provide robust support for optimizing the treatment strategies of Brucella-induced aortic aneurysms through comprehensive and in-depth data mining.

RESULTS

Among the 27 confirmed cases of infectious aortic aneurysm, a striking 51.7% (n = 15) were unequivocally diagnosed as a consequence of brucellosis-induced aneurysmal formation. Direct confirmation of brucellosis via blood culture succeeded in merely 6 cases (40%), with the remainder being verified through the combination of the Rose Bengal plate agglutination and tube agglutination tests specific to Brucella. Gender distribution among these 15 patients was heavily skewed, with a significant majority being male (n = 13) contrasting with just 2 females. Their ages spanned a range from 47 to 75 years. Delving deeper, 11 patients had a documented history of contact with cattle, sheep, pigs, or their derivatives, whereas 4 did not present with such definitive exposure. The study exhibited diversity in aneurysm locations, including 6 cases of simple abdominal aortic aneurysms (AAAs), 2 in the iliac arteries, 4 involving both abdominal and iliac arteries, a unique abdominal aortic segment harboring two distinct pseudoaneurysms, a complex case where pseudoaneurysms impacted the thoracic, abdominal, and iliac arteries concurrently, and a solitary thoracic aortic aneurysm. All patients underwent successful endovascular aneurysm repair (EVAR) utilizing a stent-graft in conjunction with drug flushing techniques. Notably, 4 patients necessitated emergency surgical intervention due to impending rupture or aneurysmal rupture. No perioperative deaths were recorded. Postoperatively, all patients received comprehensive, long-term antibiotic therapy. One patient, three days following EVAR, underwent percutaneous endoscopic lumbar discectomy and drainage for brucellar spondylitis, subsequently being transferred to the orthopedics department for further care. Another case required inferior vena cava filter implantation due to pulmonary embolism and deep venous thrombosis of the lower extremities at admission, with the filter successfully removed three months later. Furthermore, one patient was readmitted six months post-discharge for acute myocardial infarction and underwent a successful percutaneous coronary intervention (PCI).During a two-year follow-up, a patient presented with enlargement of the original pseudoaneurysm in both abdominal and iliac arteries, which was effectively addressed through repeat EVAR with a stent-graft.

CONCLUSION

The diagnosis of Brucella-induced aortic aneurysm is prone to being overlooked, and some patients present with severe conditions at their initial diagnosis. Therefore, emphasizing early diagnosis and timely antibacterial treatment is crucial for containing disease progression. The application of endovascular repair with drug flushing covered stent grafts combined with long-term, regular antibiotic therapy has proven to be a safe, effective, and feasible treatment option for Brucella-induced aortic aneurysm, worthy of widespread promotion and application in clinical practice.