Aortic endograft infection: open surgical management with endograft preservation.

INTRODUCTION: We report successful management of aortic endograft infection without graft explantation or extra-anatomic bypass. REPORT: A 66 year-old male who had undergone endovascular repair of an aortic aneurysm presented with abdominal pain and raised inflammatory markers following embolisation of a type-2 'endoleak'. CT scanning revealed a left psoas fluid collection. Endograft infection was diagnosed. Following failure of CT-guided drainage and conservative management, surgical drainage with irrigation drain placement was undertaken with preservation of the endograft. There was no evidence of recurrent infection after follow-up at 30 months. DISCUSSION: Aortic endograft infection may be managed without endograft removal and extra-anatomic bypass.     

Treatment of Aspergillus infection of the proximal aortic prosthetic graft with associated vertebral osteomyelitis

This is a case report of an unusual vascular graft infection involving an invasive Aspergillus species with associated vertebral osteomyelitis. Successful treatment was obtained by graft incision, extra-anatomic bypass, and prolonged antibiotic therapy. To our knowledge this is the first successful treatment of invasive Aspergillus of an aortic prosthetic graft. (J VASC SURG 1984;1:579-81.)     

Posttraumatic vertebral body necrosis (Kümmell-Verneuil disease)

Summary We report the case of a delayed partial posttraumatic vertebral body necrosis (PVBN) 1 year after a spinal trauma. Operative treatment became necessary due to incipient paraplegia. PVBN, also known as Kümmell-Verneuil's disease, can occur as a rare but serious complication several months or even years after a spinal trauma. Radiologically, it often presents with an intravertebral vacuum phenomenon. The underlying reasons for the necrosis as mentioned in the literature seem to be an initial microtrauma, metabolic disturbances and primarily overlooked compression fractures. Histologically, it resembles a pseudarthrosis with only little bony reparation, as in an avascular femoral head necrosis.     

Mitral valve plasty for infective endocarditis associated with vertebral osteomyelitis

Infective endocarditis (IE) associated with vertebral osteomyelitis (VO) is relatively rare, but needs long and careful therapy. We report a case of the patient who was incidentally diagnosed as having IE during therapy for VO. A 77-year-old man was hospitalized with a complaint of high fever and back pain. Because magnetic resonance imaging demonstrated osteomyelitis, antibiotic therapy was started. Persistent infectious signs and congestive heart failure indicated the diagnosis of infective endocarditis. Echocardiogram demonstrated sever mitral regurgitation due to perforation of anterior mitral leaflet but no vegetation. Surgery revealed perforation of the valvular aneurysm of the anterior mitral leaflet, which was successfully repaired with deberidement and patch closure. Antibiotic therapy was continued for 4 months postoperatively. In the case of VO, it is often necessary to consider an association of IE, although it is hardly possible to determine which the preceding infection is.     

Chronic osteomyelitis associated with cat-scratch disease

Cat-scratch disease (CSD) is usually a self-limited illness, though atypical presentations of infection with Bartonella henselae can occur, including osteomyelitis, oculoglandular syndrome, and granulomatous hepatitis. We describe a 6-year-old boy who had atypical CSD osteomyelitis of the left proximal femoral metaphysis due to a cat scratch. This is the second paper to report serial serology of B henselae, and the second paper to identify plasma cells on histologic examination, compatible with chronic osteomyelitis. The diagnosis was made by clinical, serologic, and histologic examination. Sixteen cases of atypical CSD osteomyelitis have been reported in the English literature and are reviewed in this paper.     

Aortic disease associated with pregnancy

Our experience with the management of two patients with life-threatening aortic disease during pregnancy is presented with a review of the literature. One of our patients had intimal disruption caused by trauma; the other had probable Ehlers-Danlos type IV syndrome, causing an acute dissection of the descending thoracic aorta and eventually requiring replacement of the aorta from the left subclavian artery to common iliac arteries. The challenge of treating both the pregnant woman and the fetus was managed successfully by an emergent cesarean section followed by Dacron graft replacement of the descending thoracic aorta. The literature reviewed disclosed that aneurysm expansion producing symptoms and dissection is most common during the third trimester and during labor and delivery in patients with or without Marfan's syndrome. Half of the aortic dissections in women less than 40 years of age occur in association with pregnancy. The available evidence indicates that patients with known valvular or aortic disease should have surgical repairs during the first or second trimester and thereafter have delivery by cesarean section. However, patients with acute aortic problems near term appear to be better managed by cesarean section followed promptly by treatment of the aortic disease.     

Delayed post-traumatic osteonecrosis of a vertebral body (Kummell's disease)

Kummell's disease is a rare spinal disorder characterized as avascular necrosis of a vertebral body occurring in a delayed fashion after minor trauma. The disease derives its name from the German surgeon Hermann Kummell, who described a series of patients with the disorder in 1895. Kummell's disease is distinguished from typical osteoporotic compression fractures, by virtue of the fact that patients with Kummell's disease develop symptoms in delayed fashion. In addition, Kummell's disease exhibits different signal characteristics on magnetic resonance imaging when compared to osteoporotic compression fractures. In this review we discuss the pathophysiology, histopathology and treatment of this interesting disorder.     

Primary aortoduodenal fistula in combination with aortoiliac occlusive disease: report of a rare case

Most of the cases of aortoenteric fistula are due to aneurysm of the aorta, although infection, tumor, radiotherapy, gastric ulcers and foreign body ingestion have also been described in the literature. We report the case of a 62-year-old woman presenting with massive gastrointestinal bleeding with hematemesis and melaena. This case is unique in that the primary aortoduodenal (PADF) fistula formed as a result of complex atherosclerotic disease of the abdominal aorta and both iliacal arteries, also known as Leriche's syndrome, and not primarily due to an aneurysm. We will give a brief summary of the difficulties and challenges which the surgeon faced during the operation and a surprisingly uneventful postoperative course.