Mycotic Aneurysm

Epidemiology

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Etiology

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Physiology

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Diagnosis

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Clinical Manifestations by Location of the Mycotic Aneurysm

Aorta

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Superior Mesenteric Artery

  • Epidemiology: most common visceral artery mycotic aneurysm
  • Clinical
    • Abdominal Pain (see Abdominal Pain, [[Abdominal Pain]]): may be due to rupture

Splenic Artery

  • Epidemiology: less common
  • Clinical
    • Abdominal Pain (see Abdominal Pain, [[Abdominal Pain]]): may be due to rupture

Renal Artery

  • Epidemiology: less common
  • Clinical
    • Abdominal Pain (see Abdominal Pain, [[Abdominal Pain]]): may be due to rupture

Iliac Artery

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Upper Extremity Artery

  • General Comments
    • Usually Involves the Brachial Artery: most commonly associated with intravenous drug abuse (IVDA) (see Intravenous Drug Abuse, [[Intravenous Drug Abuse]])

Lower Extremity Artery

  • General Comments
    • Usually Involve the Groin Vessels (Common Femoral Artery): although popliteal artery can be involved, involvement below the knee is rare
  • Acute Limb Ischemia (see Acute Limb Ischemia, [[Acute Limb Ischemia]])
    • Physiology: aneurysm all thrombosis
  • Clinical
    • Distal Embolization
    • Mycotic Aneurysmal Rupture
    • Painful, Pulsatile Mass (see Inguinal Mass, [[Inguinal Mass]])

Intracerebral Artery

  • General Comments
    • Distal Portions of Middle Cerebral Artery (Near the Brain Surface): most common location for cerebral mycotic aneurysms
      • In contrast, berry aneurysms tend to occur near the base of the brain and circle of Willis
  • Clinical

Other Manifestations

  • Fever (see Fever, [[Fever]])

Treatment

Treatment of Intracerebral Mycotic Aneurysm

  • Unruptured Infective Endocarditis-Associated Intracerebral Mycotic Aneurysm
    • Mortality Rate: 9%
    • Preferred Treatment: antibiotics alone
  • Ruptured Infective Endocarditis-Associated Intracerebral Mycotic Aneurysm
    • Mortality Rate: 24%
    • Preferred Treatment: surgical intervention (or endovascular management) + antibiotics (since surgical intervention decreases the mortality rate over antibiotics alone)

Treatment of Extracranial Carotid Artery Mycotic Aneurysm

  • Surgical Repair

Treatment of Thoracic Aorta Mycotic Aneurysm

  • Thoracic Endovascular Aortic Repair: probably the preferred technique
  • Surgical Repair

Treatment of Abdominal Aorta/Iliac Artery Mycotic Aneurysm

  • Surgical Repair + Antibiotics: lower mortality rate, as compared to antibiotics alone

Treatment of Lower Extremity Mycotic Aneurysm

  • Endovascular Stenting
  • Surgical Repair

References

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