92 - Postersitzung
17. Mai 2019, 12:30 - 14:00, Bellavista 2, 6. OG
A case of complicated salmonella aortitis treated by endovascular aortic repair as a bridge to definitive surgery
M. Merz, H. L. Chan, C. Haller, Presenter: M. Merz (Sion)
Infectious aortitis is a rare but life-threatening disease. An infected aorta can lead to aneurysm formation and rupture causing fatal bleeding. Currently, there is no consensus about the management of an infectious aortitis. The endovascular procedure in the early stage of the infection is starting to draw attention and even being considered by some as a long term alternative treatment. We report a case of Salmonella aortitis with perforation that were first treated by endovascular aortic repair (EVAR) as a bridge to definitive surgery.
A 76-years-old man known for a hypertension and an obesity was hospitalised in the department of internal medicine for fever with abdominal pain and a back sore. These symptoms occurred after a dinner in a restaurant 4 days earlier where the patient had eaten a raw egg. The computed tomography angiography (CTA) showed an abdominal aortitis with an periaortic collection located around the inferior mesenteric artery with positive blood cultures for Salmonella Enteritidis. A medical management was initiated with high doses of Ceftriaxone. A second CTA was performed 48 hours later and showed a perforation of his abdominal aorta and the patient underwent an emergent EVAR as a bridge to definitive surgery. A week later, an abdominal aorta replacement with homograft was successfully performed. The antimicrobial treatment was carried on for 4 weeks intravenously followed by 3 months of oral Ciprofloxacin. The patient was discharged at postoperative day 9 and the result was favorable and uneventful at 6-month follow-up.
Open surgery is currently considered as the treatment of choice for Salmonella aortitis. However, the endovascular procedure was reported to have good results in the emergency management of complications of Salmonella aortitis and there is growing interests regarding the use of EVAR in infectious aortitis, especially for the high operative risk patients.
In an urgent situation such as an aortic perforation in Salmonella aortitis, EVAR should be performed first in order to save the patient’s life, before considering a definitive surgery.