J Thorac Cardiovasc Surg 2008;135:1404
© 2008 The American Association for Thoracic Surgery
Endovascular treatment of mycotic aortic aneurysms
Dilek Erer, MDa,
Maciej Banach, MDb,
Murat Ugurlucan, MDc
a Department of Cardiovascular Surgery, Gazi University Medical Faculty, Ankara, Turkey
b Department of Cardiology, Lodz University Medical Faculty, Lodz, Poland
c Department of Cardiovascular Surgery, Istanbul University Istanbul Medical Faculty, Istanbul, Turkey
To the Editor:
We read with interest the article by Hsu and Lin1
in which they retrospectively reviewed their patients who received surgical treatment for infected aortic aneurysms at the aortic arch. Mycotic aortic aneurysm treatment is a challenging issue. Since the beginning of modern cardiovascular surgery, surgeons have searched for better treatment options because of the high mortality and morbidity rates of the classic surgical methods. The authors' results also confirm this.1
With the increasing experience and refinements in graft technology, endovascular grafts are frequently used in the treatment of aneurysms at critical segments of the aorta, such as thoracic and arch levels,2 and even to the ascending aorta by means of hybrid therapy or alone.3
On the other hand, although it seems completely opposite to the nature of the treatment of infected aneurysms, endoluminal stent grafting is also applied for the treatment of mycotic aneurysms. Although the long-term results are not presented, the short and midterm outcomes of this treatment modality have been promising when compared with conventional surgical techniques (ie, extensive debridement and artificial graft replacement or extra-anatomic bypass procedures).4,5
We believe that endovascular stent graft repair of mycotic aortic aneurysms, especially at the critical segments of the aorta and in debilitated patients, is an attractive alternative option with low mortality and morbidity rates in the midterm. However, long-term results are definitely required before this becomes the standard therapy. It would be helpful if the authors would have commented on this issue in their article.
References
- Hsu RB, Lin FY. Surgery for infected aneurysm of the aortic arch. J Thorac Cardiovasc Surg 2007;134:1157-1162.[Abstract/Free Full Text]
- Ugurlucan M, Akyol Y, Guven K, Poyanli A, Alpagut U, Rozanes I, et al. Treatment of chronic type B aortic dissection by endovascular grafting in a previously CABG patient. Acta Chir Belg 2007;107:419-423.[Medline]
- Mussa FF, LeMaire SA, Bozinovski J, Coselli JS. An entirely endovascular approach to the repair of an ascending aortic pseudoaneurysm. J Thorac Cardiovasc Surg 2007;133:562-563.[Free Full Text]
- Ugurlucan M, Alpagut U. Endoluminal stenting of thoracic aorta mycotic aneurysms. Eur J Cardiothorac Surg 2007;32:945-946.[Free Full Text]
- Kpodonu J, Williams JP, Ramaiah VG, Diethrich EB. Endovascular management of a descending thoracic mycotic aneurysm: mid-term follow-up. Eur J Cardiothorac Surg 2007;32:178-179.[Abstract/Free Full Text]
