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Mycotic aortic aneurysms : what do we know? Analysis of a small unicentric cohort
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Resumo(s)
Os aneurismas micóticos caracterizam-se pela infeção de um aneurisma por um qualquer microrganismo, representando uma ínfima parte da patologia vascular. Existem inúmeros fatores de risco mencionados, mais concretamente, aqueles que diminuem o estado imunológico do doente, aumentado a propensão para infeção.
Dentro das várias causas etiológicas, a infeção a Staphylococcus spp por disseminação hematogénea é apontada como das principais causas, ainda que a positividade das culturas não seja observada numa grande parte da população.
A sua apresentação clínica é bastante inespecífica, apresentando-se maioritariamente como um quadro de febre de origem indeterminada, o que acaba por dificultar e atrasar o seu diagnóstico. Em casos extremos, pode apresentar-se sob a forma de rotura aneurismática.
O diagnóstico de um aneurisma micótico é feito com base num conjunto de características clínicas, laboratoriais, culturais e imagiológicas, não tendo, contudo, um algoritmo específico.
O tratamento, ainda que controverso, recai sobre antibioterapia, de forma a controlar o foco infecioso, possivelmente ainda antes da abordagem cirúrgica, que tanto poderá ser por via aberta ou endovascular.
Este estudo pretende comparar as características etiológicas e terapêuticas- via endovascular vs via cirurgia convencional aberta- e seus outcomes, de uma pequena população com diagnóstico de aneurisma micótico, do Serviço de Cirurgia Vascular, baseado na literatura mais recente.
Mycotic aneurysms are an infection of an aneurysm by some microorganism, representing a very small part of vascular pathology. There are numerous risk factors mentioned, more specifically, those that lower the immune status of the patient, increasing the propensity for infection. Among the various etiological causes, infection by Staphylococcus spp. through hematogenous dissemination is pointed out as one of the main causes, even though the culture positivity is not observed in a large part of the population. Its clinical presentation is quite non-specific, mostly presenting as a fever of undetermined origin, which makes the diagnosis more difficult and delays it. In extreme cases, it may even present as aneurysmal rupture. The diagnosis of a mycotic aneurysm is made based on a set of clinical, laboratory, cultural, imaging and infectious pattern characteristics, but there is no specific algorithm. The treatment, although controversial, relies on antibiotic therapy in order to control the infectious site, possibly even before the surgical approach, which may be either open or endovascular. This study aims to compare the etiological and therapeutic characteristics - endovascular versus conventional open surgery - and their outcomes in a small population diagnosed with mycotic aneurysm at the Vascular Surgery Service, based on the most recent literature.
Mycotic aneurysms are an infection of an aneurysm by some microorganism, representing a very small part of vascular pathology. There are numerous risk factors mentioned, more specifically, those that lower the immune status of the patient, increasing the propensity for infection. Among the various etiological causes, infection by Staphylococcus spp. through hematogenous dissemination is pointed out as one of the main causes, even though the culture positivity is not observed in a large part of the population. Its clinical presentation is quite non-specific, mostly presenting as a fever of undetermined origin, which makes the diagnosis more difficult and delays it. In extreme cases, it may even present as aneurysmal rupture. The diagnosis of a mycotic aneurysm is made based on a set of clinical, laboratory, cultural, imaging and infectious pattern characteristics, but there is no specific algorithm. The treatment, although controversial, relies on antibiotic therapy in order to control the infectious site, possibly even before the surgical approach, which may be either open or endovascular. This study aims to compare the etiological and therapeutic characteristics - endovascular versus conventional open surgery - and their outcomes in a small population diagnosed with mycotic aneurysm at the Vascular Surgery Service, based on the most recent literature.
Descrição
Trabalho Final do Curso de Mestrado Integrado em Medicina, Faculdade de Medicina, Universidade de Lisboa, 2023
Palavras-chave
Aneurisma micótico Cirurgia endovascular Cirurgia convencional aberta Staphylococcus spp Cirurgia vascular