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
  • Intracerebral Hemorrhage (Hemorrhagic Cerebrovascular Accident) (see Intracerebral Hemorrhage, [[Intracerebral Hemorrhage]])
  • Subarachnoid Hemorrhage (SAH) (see Subarachnoid Hemorrhage, [[Subarachnoid Hemorrhage]])

Other Manifestations

• Fever (see Fever, [[Fever]])

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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

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References

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