Tuberculous Aneurysm of the Abdominal Aorta: Endovascular Repair Using Stent Grafts in Two Cases

Repair Using Stent Grafts in Two CasesTuberculous aneurysm of the aorta is exceedingly rare.To date, the standard therapy for mycotic aneurysm of the abdominal aorta has been surgery involving in-situ graft placement or extra-anatomic bypass surgery followed by effective anti-tuberculous medication.Only recently has the use of a stent graft in the treatment of tuberculous aortic aneurysm been described in the literature.We report two cases in which a tuberculous aneurysm of the abdominal aorta was successfully repaired using endovascular stent grafts.One case involved is a 42-year-old woman with a large suprarenal abdominal aortic aneurysm and a right psoas abscess, and the other, a 41-year-old man in whom an abdominal aortic aneurysm ruptured during surgical drainage of a psoas abscess.uberculous aneurysm of the aorta occurs only rarely.During the past 54 years, since the introduction of anti-tuberculous drug therapy, only 43 such cases have been reported in the English literature (1).The first case of tuberculous involvement of the aorta (aortitis) was reported by Weigert in 1882 (2), and no patients are known to have survived a tuberculous aortic aneurysm until the combined technologies of modern imaging capability, anti-tuberculous drugs and vascular grafts became available.In 1952, Herndon et al (3) attempted the first surgical repair of a tuberculous aortic aneurysm, but the patient died six days after surgery.In 1955, Rob and Eastcott (4), using an Orlon cloth graft, reported the first successful reconstruction in such a case.Tuberculous aneurysm of the aorta is noteworthy because of the high risk of sudden rupture if neither medical nor surgical treatment is attempted, and no patients have survived without medical therapy.Those who underwent surgery but did not receive anti-tuberculous drugs died, as did those who did not undergo surgery.With the early recognition of aneurysms and prompt surgical treatment by means of in-situ graft placement or extra-anatomic bypass surgery followed by anti-tuberculous medication, successful treatment is now possible, however.This report describes two cases involving successful repair of tuberculous aneurysm of the abdominal aorta using endovascular stent grafts.