Management of nocardia associated infected ruptured paravisceral aortic aneurysm with preserved allograft and long-term antimicrobial suppression

Abstract

Infective aneurysms of the aorta are associated with high morbidity and mortality. They are typically caused by Staphylococcus, and to a lesser extent, salmonella species. Nocardia is one of the more virulent organisms. Optimal outcomes rely on early diagnosis, timely initiation of broad-spectrum antibiotics and early source control. We present a ruptured paravisceral infective aortic aneurysm related to nocardiosis in an immunocompromised patient. Operative repair included thoraco-abdominal aneurysmal repair with aortic preserved allograft with reimplantation of the involved renal artery and bypass to the superior mesenteric artery (SMA) and celiac artery. This was followed by indefinite suppressive antibiotics. Three years follow up showed stable repair with no recurrence.

Keywords

• Nocardiosis
• Mycotic aneurysm
• Cryopreserved graft