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Aneurisma infeccioso primário da aorta: série de casos e revisão da literatura

Resumo

Aneurismas infecciosos, anteriormente chamados de aneurismas micóticos, são raros; acometem com maior frequência a aorta de pacientes jovens e apresentam maior tendência à rotura do que aneurismas de outras etiologias. O formato sacular é o mais característico, e os agentes etiológicos mais comuns são Staphylococcus sp e Salmonella sp. A literatura fornece informações limitadas e imprecisas sobre a correta nomenclatura, diagnóstico e tratamento da doença. Os autores reuniram três casos cujos procedimentos diagnósticos e terapêuticos foram documentados. Além de relatar essa série de casos, realiza-se uma revisão sobre o tema, a fim de estabelecer estratégias diagnósticas e terapêuticas pertinentes.

Palavras-chave:
aneurisma infectado; aneurisma aórtico; aneurisma da aorta abdominal; aneurisma aórtico roto

Abstract

Infectious aneurysms, formerly known as mycotic aneurysms, are rare, most often involve the aorta in young patients, and have a greater tendency to rupture than aneurysms of other etiologies. The most characteristic shape is saccular and the most common etiologic agents are Staphylococcus sp. and Salmonella sp. There is scant and imprecise information in the literature about correct nomenclature, diagnosis, and treatment. The authors present three cases in which diagnostic and therapeutic procedures were documented. In addition to reporting this case series, the authors also present a review of the subject, outlining pertinent diagnostic and therapeutic strategies.

Keywords:
infectious aneurysm; aortic aneurysm; abdominal aortic aneurysm; ruptured aortic aneurysm

INTRODUÇÃO

Aneurismas infecciosos, anteriormente chamados de aneurismas micóticos, são raros: correspondem a 1-3% entre todos os aneurismas11 Hurtado DFG, Neira JCH, Atala SH, Lawrence PT. Manejo de un aneurisma infeccioso. Rev Cir. 2019;71(5):446-9.,22 Dsouza R, Kota AA, Jain S, Agarwal S. Mycotic abdominal aortic aneurysm complicated by infective spondylitis due to Pseudomonas aeruginosa. BMJ Case Rep. 2020;13(2):1-3. http://dx.doi.org/10.1136/bcr-2019-233461.
http://dx.doi.org/10.1136/bcr-2019-23346...
. Com maior frequência acometem a aorta22 Dsouza R, Kota AA, Jain S, Agarwal S. Mycotic abdominal aortic aneurysm complicated by infective spondylitis due to Pseudomonas aeruginosa. BMJ Case Rep. 2020;13(2):1-3. http://dx.doi.org/10.1136/bcr-2019-233461.
http://dx.doi.org/10.1136/bcr-2019-23346...
,33 Nagrodzki J, Sharrocks KE, Wong VK, Carmichael AJ. A mycotic aneurysm related to Salmonella Rissen infection: a case report. BMC Infect Dis. 2020;20(1):97. http://dx.doi.org/10.1186/s12879-020-4819-0. PMid:32005105.
http://dx.doi.org/10.1186/s12879-020-481...
de homens jovens44 Kordzadeh A, Watson J, Panayiotopolous YP. Mycotic aneurysm of the superior and inferior mesenteric artery. J Vasc Surg. 2016;63(6):1638-46. http://dx.doi.org/10.1016/j.jvs.2016.01.031. PMid:26951998.
http://dx.doi.org/10.1016/j.jvs.2016.01....
; o formato sacular é o mais característico55 Sörelius K, di Summa PG. On the diagnosis of mycotic aortic aneurysms. Clin Med Insights Cardiol. 2018;12:1179546818759678. http://dx.doi.org/10.1177/1179546818759678. PMid:29497343.
http://dx.doi.org/10.1177/11795468187596...
e há maior tendência à rotura do que em aneurismas não infecciosos66 Guo Y, Bai Y, Yang C, Wang P, Gu L. Mycotic aneurysm due to Salmonella species: clinical experiences and review of the literature. Braz J Med Biol Res. 2018;51(9):e6864. http://dx.doi.org/10.1590/1414-431x20186864. PMid:29947649.
http://dx.doi.org/10.1590/1414-431x20186...
,77 Kano Y, Takamatsu A, Honda H. Mycotic aneurysm due to Pasteurella multocida. QJM. 2020;113(9):667-9. PMid:32016425.. Os agentes etiológicos mais comuns são Staphylococcus sp e Salmonella sp66 Guo Y, Bai Y, Yang C, Wang P, Gu L. Mycotic aneurysm due to Salmonella species: clinical experiences and review of the literature. Braz J Med Biol Res. 2018;51(9):e6864. http://dx.doi.org/10.1590/1414-431x20186864. PMid:29947649.
http://dx.doi.org/10.1590/1414-431x20186...

7 Kano Y, Takamatsu A, Honda H. Mycotic aneurysm due to Pasteurella multocida. QJM. 2020;113(9):667-9. PMid:32016425.
-88 Deipolyi AR, Czaplicki CD, Oklu R. Inflammatory and infectious aortic diseases. Cardiovasc Diagn Ther. 2018;8(Suppl 1):S61-70. http://dx.doi.org/10.21037/cdt.2017.09.03. PMid:29850419.
http://dx.doi.org/10.21037/cdt.2017.09.0...
. Aneurismas infecciosos podem estar associados a uso de drogas ilícitas injetáveis44 Kordzadeh A, Watson J, Panayiotopolous YP. Mycotic aneurysm of the superior and inferior mesenteric artery. J Vasc Surg. 2016;63(6):1638-46. http://dx.doi.org/10.1016/j.jvs.2016.01.031. PMid:26951998.
http://dx.doi.org/10.1016/j.jvs.2016.01....
,88 Deipolyi AR, Czaplicki CD, Oklu R. Inflammatory and infectious aortic diseases. Cardiovasc Diagn Ther. 2018;8(Suppl 1):S61-70. http://dx.doi.org/10.21037/cdt.2017.09.03. PMid:29850419.
http://dx.doi.org/10.21037/cdt.2017.09.0...
, imunossupressão ou sepse11 Hurtado DFG, Neira JCH, Atala SH, Lawrence PT. Manejo de un aneurisma infeccioso. Rev Cir. 2019;71(5):446-9.,44 Kordzadeh A, Watson J, Panayiotopolous YP. Mycotic aneurysm of the superior and inferior mesenteric artery. J Vasc Surg. 2016;63(6):1638-46. http://dx.doi.org/10.1016/j.jvs.2016.01.031. PMid:26951998.
http://dx.doi.org/10.1016/j.jvs.2016.01....
. O diagnóstico é dificultado pela baixa prevalência e pela inespecificidade de sinais e sintomas66 Guo Y, Bai Y, Yang C, Wang P, Gu L. Mycotic aneurysm due to Salmonella species: clinical experiences and review of the literature. Braz J Med Biol Res. 2018;51(9):e6864. http://dx.doi.org/10.1590/1414-431x20186864. PMid:29947649.
http://dx.doi.org/10.1590/1414-431x20186...

7 Kano Y, Takamatsu A, Honda H. Mycotic aneurysm due to Pasteurella multocida. QJM. 2020;113(9):667-9. PMid:32016425.
-88 Deipolyi AR, Czaplicki CD, Oklu R. Inflammatory and infectious aortic diseases. Cardiovasc Diagn Ther. 2018;8(Suppl 1):S61-70. http://dx.doi.org/10.21037/cdt.2017.09.03. PMid:29850419.
http://dx.doi.org/10.21037/cdt.2017.09.0...
. Febre, massa pulsátil e dor abdominal são classicamente descritas, assim como marcadores inflamatórios elevados e hemoculturas positivas; porém, isso nem sempre acontece33 Nagrodzki J, Sharrocks KE, Wong VK, Carmichael AJ. A mycotic aneurysm related to Salmonella Rissen infection: a case report. BMC Infect Dis. 2020;20(1):97. http://dx.doi.org/10.1186/s12879-020-4819-0. PMid:32005105.
http://dx.doi.org/10.1186/s12879-020-481...
,99 Zeng Z, Li Z, Zhao Y, et al. Endovascular repair combined with staged drainage for the treatment of infectious aortic aneurysm: a case report. BMC Cardiovasc Disord. 2020;20(1):406. http://dx.doi.org/10.1186/s12872-020-01694-9. PMid:32894058.
http://dx.doi.org/10.1186/s12872-020-016...
. Esse tipo de aneurisma requer rápida instituição do tratamento, que engloba antibioticoterapia (idealmente orientada por culturas) e cirurgia11 Hurtado DFG, Neira JCH, Atala SH, Lawrence PT. Manejo de un aneurisma infeccioso. Rev Cir. 2019;71(5):446-9.,66 Guo Y, Bai Y, Yang C, Wang P, Gu L. Mycotic aneurysm due to Salmonella species: clinical experiences and review of the literature. Braz J Med Biol Res. 2018;51(9):e6864. http://dx.doi.org/10.1590/1414-431x20186864. PMid:29947649.
http://dx.doi.org/10.1590/1414-431x20186...

7 Kano Y, Takamatsu A, Honda H. Mycotic aneurysm due to Pasteurella multocida. QJM. 2020;113(9):667-9. PMid:32016425.

8 Deipolyi AR, Czaplicki CD, Oklu R. Inflammatory and infectious aortic diseases. Cardiovasc Diagn Ther. 2018;8(Suppl 1):S61-70. http://dx.doi.org/10.21037/cdt.2017.09.03. PMid:29850419.
http://dx.doi.org/10.21037/cdt.2017.09.0...
-99 Zeng Z, Li Z, Zhao Y, et al. Endovascular repair combined with staged drainage for the treatment of infectious aortic aneurysm: a case report. BMC Cardiovasc Disord. 2020;20(1):406. http://dx.doi.org/10.1186/s12872-020-01694-9. PMid:32894058.
http://dx.doi.org/10.1186/s12872-020-016...
. Poucos cirurgiões acumulam experiência no tratamento, e a literatura fornece informações imprecisas sobre nomenclatura, critérios diagnósticos e estratégias terapêuticas. Este artigo apresenta uma série de três casos e salienta aspectos de apresentação clínica, diagnóstico e terapêutica, além de revisar a literatura sobre o tema para ajudar a padronizar a abordagem dessa doença incomum, porém extremamente grave. Esta série de casos foi apreciada e aprovada pelo Comitê de Ética da instituição de origem, sob o parecer de número 48950921.5.0000.5169.

DESCRIÇÃO DOS CASOS

Caso 1

Homem, 44 anos, encaminhado para acompanhamento após trombose venosa profunda (TVP). Apresentava dor, eritema e edema em ambas as pernas. Havia feito tratamento de erisipela com penicilina G benzatina e, após 4 meses, apresentou novo quadro semelhante, com sintomas mais exuberantes e restritos ao membro inferior esquerdo, acompanhados de edema e empastamento. Fez-se novo ciclo de penicilina, e exame de eco-Doppler confirmou TVP de veias femorais comum, superficial e profunda, para a qual foi prescrita rivaroxabana por 6 meses. Quando o paciente foi avaliado pelo cirurgião vascular, o tratamento já havia sido concluído. No entanto, referia dor abdominal. Durante o segundo episódio de erisipela (8 meses antes da consulta), relatou episódio de dor lombar e abdominal aguda e intensa, que melhorou após alguns dias, persistindo com menor intensidade. A dor foi atribuída à espondilite anquilosante (diagnosticada há 13 anos), para a qual o paciente usava injeções subcutâneas de adalimumabe. Negava febre, perda de peso e uso de drogas ilícitas. Ao exame físico, apresentava massa pulsátil dolorosa com sopro audível no mesogástrio. Hemoglobina e leucócitos estavam dentro dos valores de referência; porém, velocidade de hemossedimentação (VHS) e proteína C reativa (PCR) encontravam-se elevadas (22 e 12, respectivamente). A angiotomografia mostrou aneurisma fusiforme da aorta infrarrenal, com diâmetro máximo de 3,6 cm e contornos lobulados, circundado por hematoma hipodenso, sem sinais de sangramento ativo, porém com descontinuidade das calcificações parietais e ulcerações penetrantes, além de perda da definição do contorno aórtico posterior, o que sugeria aneurisma de aorta abdominal infrarenal com sinais de rotura contida (Figura 1). O paciente foi internado. Hemoculturas foram negativas e ecocardiograma não apresentou sinais de endocardite. Administraram-se ciprofloxacina e clindamicina endovenosas por 14 dias. À laparotomia, no 15º dia, não foram observados odor fétido ou coleção líquida, porém havia intensa fibrose, espessamento da parede arterial e aderência dos tecidos adjacentes. O controle proximal foi obtido por clampeamento infrarrenal. Não foi possível a dissecção do colo distal devido à fibrose. O controle distal foi estabelecido pela insuflação intraluminal de sondas de Foley nas ilíacas comuns (Figura 2A). Após arteriotomia longitudinal e retirada de trombos, confirmou-se rotura contida na parede posterior do aneurisma. A aorta foi ressecada o máximo possível, inclusive sua parede posterior, com sutura dos cotos das artérias lombares. Para reconstrução, utilizou-se enxerto aorto-aórtico com prótese de Dacron de 20 mm de diâmetro, envolvido por um pedículo vascularizado do grande omento (Figuras 2B, 2C e 3). Culturas de trombo e parede aórtica foram negativas. A antibioticoterapia endovenosa foi mantida até a alta, no 14º dia de pós-operatório (PO). Foram prescritas ciprofloxacina e clindamicina por via oral por mais 6 semanas, e o uso de adalimumabe foi suspenso. O paciente está em acompanhamento ambulatorial há 6 meses.

Figura 1
Tomografia computadorizada com contraste endovenoso. (A) Corte axial; A: aorta; os asteriscos correspondem a imagem compatível com coleção/massa periaórtica; (B) Reconstrução com técnica maximum intensity projection (MIP). Observar as irregularidades de contorno não apenas do aneurisma mas também dos segmentos aórticos proximais (seta preta) e distais (setas brancas) ao aneurisma.
Figura 2
Intraoperatório. (A) Hemostasia temporária com insuflação endoluminal de sondas de Foley nas artérias ilíacas; (B) Pedículo vascularizado do grande omento; (C) Pedículo do grande omento já posicionado para envolver o enxerto tubular de Dácron.
Figura 3
Representação de enxerto tubular de Dácron. (A) Omento, artéria gastromental direita (seta fina) e artéria gastromental esquerda (seta grossa); (B) Aorta abdominal após enxerto de Dácron; (C) Omento envolvendo a prótese na aorta abdominal.

Caso 2

Homem, 62 anos, internado por dor abdominal recorrente após atendimentos ambulatoriais. Relatava gastroenterite grave, tratada com antibioticoterapia 4 meses antes. Havia dor abdominal difusa, mais intensa no mesogástrio; angiotomografia confirmou aneurisma aórtico justarrenal de 5,3 cm de diâmetro, com sinais inflamatórios periaórticos. O paciente apresentava PCR elevado (34 mg/L) e leucocitose de 17.000/µL; hemocultura foi negativa. Após 7 dias de ciprofloxacina e clindamicina endovenosas, o paciente foi operado. Observaram-se os seguintes achados operatórios: alças intestinais com aspecto inflamatório e odor fétido após abertura do saco aneurismático. Foram realizados clampeamento proximal supracelíaco e reconstrução com enxerto aorto-aórtico com prótese de Dacron de 18 mm (Figura 4). No pós-operatório, o paciente evoluiu com disfunção renal e pneumonia hospitalar; a cultura da parede aórtica evidenciou Escherichia coli, e a antibioticoterapia foi modificada para piperacilina com tazobactam e vancomicina. O paciente foi a óbito no 9º PO.

Figura 4
Intraoperatório. (A) Volumoso aneurisma de aorta infrarrenal; (B) Enxerto tubular de Dácron. A seta aponta a área onde a parede posterior da aorta foi ressecada, anastomose proximal já concluída.

Caso 3

Homem, 59 anos, com internações anteriores por quadros psiquiátricos, admitido por dor abdominal. Ao exame físico, apresentava dor à palpação profunda do mesogástrio com massa pulsátil. A angiotomografia confirmou aneurisma justarrenal sacular de 5,7 cm e coleção periaórtica (Figura 5). O paciente apresentava VHS normal, PCR elevada (27 mg/L) e leucocitose (21.000/µL). Hemocultura demonstrou Staphylococcus coagulase negativo, e iniciou-se antibioticoterapia com teicoplanina e piperacilina com tazobactam. Após 7 dias, já com a hemocultura negativa, foi realizado tratamento cirúrgico. O controle aórtico proximal requereu clampeamento supracelíaco. Odor forte e rotura contida de parede posterior foram notados à abertura do saco aneurismático. A reconstrução foi com enxerto aorto-ilíaco com prótese bifurcada de Dacron 18x9 mm envolvido com pedículo vascularizado do grande omento (Figura 6). No PO, a antibioticoterapia foi mantida por 30 dias. Um ano após a alta, o paciente foi submetido a cirurgia por aneurismas degenerativos bilaterais de artéria femoral comum (etiologia infecciosa descartada). Encontra-se em seguimento ambulatorial 2 anos após tratamento do aneurisma aórtico infeccioso.

Figura 5
Tomografia computadorizada com contraste endovenoso, corte axial. (A) Aorta; os asteriscos correspondem a imagem compatível com coleção/massa periaórtica.
Figura 6
Intraoperatório. Enxerto aorto-ilíaco com prótese bifurcada de Dácron impregnada com prata.

Um ponto comum aos três casos descritos nesta série é o fato da angiotomografia não ter demonstrado gás periaórtico.

DISCUSSÃO

O termo aneurisma micótico foi cunhado por William Osler em 18851010 Osler W. The gulstonian lectures, on malignant endocarditis. Br Med J. 1885;1(1262):467-70. http://dx.doi.org/10.1136/bmj.1.1262.467. PMid:20751186.
http://dx.doi.org/10.1136/bmj.1.1262.467...
, devido ao aspecto de cogumelo das lesões aneurismáticas1010 Osler W. The gulstonian lectures, on malignant endocarditis. Br Med J. 1885;1(1262):467-70. http://dx.doi.org/10.1136/bmj.1.1262.467. PMid:20751186.
http://dx.doi.org/10.1136/bmj.1.1262.467...
,1111 Wanhainen A, Verzini F, Van Herzeele I, et al. Editor’s Choice - European Society for Vascular Surgery (ESVS) 2019 Clinical Practice Guidelines on the Management of Abdominal Aorto-iliac Artery Aneurysms. Eur J Vasc Endovasc Surg. 2019;57(1):8-93. http://dx.doi.org/10.1016/j.ejvs.2018.09.020. PMid:30528142.
http://dx.doi.org/10.1016/j.ejvs.2018.09...
. Porém, induzia à ideia equivocada de etiologia fúngica55 Sörelius K, di Summa PG. On the diagnosis of mycotic aortic aneurysms. Clin Med Insights Cardiol. 2018;12:1179546818759678. http://dx.doi.org/10.1177/1179546818759678. PMid:29497343.
http://dx.doi.org/10.1177/11795468187596...
,1111 Wanhainen A, Verzini F, Van Herzeele I, et al. Editor’s Choice - European Society for Vascular Surgery (ESVS) 2019 Clinical Practice Guidelines on the Management of Abdominal Aorto-iliac Artery Aneurysms. Eur J Vasc Endovasc Surg. 2019;57(1):8-93. http://dx.doi.org/10.1016/j.ejvs.2018.09.020. PMid:30528142.
http://dx.doi.org/10.1016/j.ejvs.2018.09...
. A denominação aortite infecciosa pode corresponder a várias situações, como fístulas aortoentéricas e infecções após manipulação cirúrgica, inclusive infecções de enxertos aórticos55 Sörelius K, di Summa PG. On the diagnosis of mycotic aortic aneurysms. Clin Med Insights Cardiol. 2018;12:1179546818759678. http://dx.doi.org/10.1177/1179546818759678. PMid:29497343.
http://dx.doi.org/10.1177/11795468187596...
,88 Deipolyi AR, Czaplicki CD, Oklu R. Inflammatory and infectious aortic diseases. Cardiovasc Diagn Ther. 2018;8(Suppl 1):S61-70. http://dx.doi.org/10.21037/cdt.2017.09.03. PMid:29850419.
http://dx.doi.org/10.21037/cdt.2017.09.0...
,1212 Zhu C, Zhao J, Huang B, Yuan D, Yang Y, Wang T. Long‐term outcome of endovascular aortic repair for mycotic abdominal aortic aneurysm. ANZ J Surg. 2020;90(7-8):1376-80. http://dx.doi.org/10.1111/ans.16122. PMid:32648327.
http://dx.doi.org/10.1111/ans.16122...

13 Berchiolli R, Mocellin DM, Marconi M, et al. Ruptured mycotic aneurysm after intravesical instillation for bladder tumor. Ann Vasc Surg. 2019;59:310.e7-310.e11. http://dx.doi.org/10.1016/j.avsg.2018.12.100. PMid:30802589.
http://dx.doi.org/10.1016/j.avsg.2018.12...
-1414 Wilson WR, Bower TC, Creager MA, et al. Vascular Graft Infections, Mycotic Aneurysms, and Endovascular Infections: a scientific statement from the American Heart Association. Circulation. 2016;134(20):e412-e460. http://dx.doi.org/10.1161/CIR.0000000000000457. PMid:27737955.
http://dx.doi.org/10.1161/CIR.0000000000...
. A melhor denominação é aneurisma infeccioso primário, que representa dilatação secundária à infecção parietal da aorta22 Dsouza R, Kota AA, Jain S, Agarwal S. Mycotic abdominal aortic aneurysm complicated by infective spondylitis due to Pseudomonas aeruginosa. BMJ Case Rep. 2020;13(2):1-3. http://dx.doi.org/10.1136/bcr-2019-233461.
http://dx.doi.org/10.1136/bcr-2019-23346...
,55 Sörelius K, di Summa PG. On the diagnosis of mycotic aortic aneurysms. Clin Med Insights Cardiol. 2018;12:1179546818759678. http://dx.doi.org/10.1177/1179546818759678. PMid:29497343.
http://dx.doi.org/10.1177/11795468187596...
,1111 Wanhainen A, Verzini F, Van Herzeele I, et al. Editor’s Choice - European Society for Vascular Surgery (ESVS) 2019 Clinical Practice Guidelines on the Management of Abdominal Aorto-iliac Artery Aneurysms. Eur J Vasc Endovasc Surg. 2019;57(1):8-93. http://dx.doi.org/10.1016/j.ejvs.2018.09.020. PMid:30528142.
http://dx.doi.org/10.1016/j.ejvs.2018.09...
,1414 Wilson WR, Bower TC, Creager MA, et al. Vascular Graft Infections, Mycotic Aneurysms, and Endovascular Infections: a scientific statement from the American Heart Association. Circulation. 2016;134(20):e412-e460. http://dx.doi.org/10.1161/CIR.0000000000000457. PMid:27737955.
http://dx.doi.org/10.1161/CIR.0000000000...
,1515 Dang Q, Van Eps RG, Wever JJ, et al. Nationwide study of the treatment of mycotic abdominal aortic aneurysms comparing open and endovascular repair in The Netherlands. J Vasc Surg. 2020;72(2):531-40. http://dx.doi.org/10.1016/j.jvs.2019.09.060. PMid:32061482.
http://dx.doi.org/10.1016/j.jvs.2019.09....
. É raro11 Hurtado DFG, Neira JCH, Atala SH, Lawrence PT. Manejo de un aneurisma infeccioso. Rev Cir. 2019;71(5):446-9.,55 Sörelius K, di Summa PG. On the diagnosis of mycotic aortic aneurysms. Clin Med Insights Cardiol. 2018;12:1179546818759678. http://dx.doi.org/10.1177/1179546818759678. PMid:29497343.
http://dx.doi.org/10.1177/11795468187596...

6 Guo Y, Bai Y, Yang C, Wang P, Gu L. Mycotic aneurysm due to Salmonella species: clinical experiences and review of the literature. Braz J Med Biol Res. 2018;51(9):e6864. http://dx.doi.org/10.1590/1414-431x20186864. PMid:29947649.
http://dx.doi.org/10.1590/1414-431x20186...
-77 Kano Y, Takamatsu A, Honda H. Mycotic aneurysm due to Pasteurella multocida. QJM. 2020;113(9):667-9. PMid:32016425.,99 Zeng Z, Li Z, Zhao Y, et al. Endovascular repair combined with staged drainage for the treatment of infectious aortic aneurysm: a case report. BMC Cardiovasc Disord. 2020;20(1):406. http://dx.doi.org/10.1186/s12872-020-01694-9. PMid:32894058.
http://dx.doi.org/10.1186/s12872-020-016...
,1616 Sörelius K, Wanhainen A, Furebring M, et al. Nationwide study of the treatment of mycotic abdominal aortic aneurysms comparing open and endovascular repair. Circulation. 2016;134(23):1822-32. http://dx.doi.org/10.1161/CIRCULATIONAHA.116.024021. PMid:27799273.
http://dx.doi.org/10.1161/CIRCULATIONAHA...
, porém altamente letal66 Guo Y, Bai Y, Yang C, Wang P, Gu L. Mycotic aneurysm due to Salmonella species: clinical experiences and review of the literature. Braz J Med Biol Res. 2018;51(9):e6864. http://dx.doi.org/10.1590/1414-431x20186864. PMid:29947649.
http://dx.doi.org/10.1590/1414-431x20186...
-77 Kano Y, Takamatsu A, Honda H. Mycotic aneurysm due to Pasteurella multocida. QJM. 2020;113(9):667-9. PMid:32016425.,99 Zeng Z, Li Z, Zhao Y, et al. Endovascular repair combined with staged drainage for the treatment of infectious aortic aneurysm: a case report. BMC Cardiovasc Disord. 2020;20(1):406. http://dx.doi.org/10.1186/s12872-020-01694-9. PMid:32894058.
http://dx.doi.org/10.1186/s12872-020-016...
,1616 Sörelius K, Wanhainen A, Furebring M, et al. Nationwide study of the treatment of mycotic abdominal aortic aneurysms comparing open and endovascular repair. Circulation. 2016;134(23):1822-32. http://dx.doi.org/10.1161/CIRCULATIONAHA.116.024021. PMid:27799273.
http://dx.doi.org/10.1161/CIRCULATIONAHA...
.

No Ocidente, aneurismas infecciosos não ultrapassam 3% entre todos os aneurismas11 Hurtado DFG, Neira JCH, Atala SH, Lawrence PT. Manejo de un aneurisma infeccioso. Rev Cir. 2019;71(5):446-9.,22 Dsouza R, Kota AA, Jain S, Agarwal S. Mycotic abdominal aortic aneurysm complicated by infective spondylitis due to Pseudomonas aeruginosa. BMJ Case Rep. 2020;13(2):1-3. http://dx.doi.org/10.1136/bcr-2019-233461.
http://dx.doi.org/10.1136/bcr-2019-23346...
,55 Sörelius K, di Summa PG. On the diagnosis of mycotic aortic aneurysms. Clin Med Insights Cardiol. 2018;12:1179546818759678. http://dx.doi.org/10.1177/1179546818759678. PMid:29497343.
http://dx.doi.org/10.1177/11795468187596...
,66 Guo Y, Bai Y, Yang C, Wang P, Gu L. Mycotic aneurysm due to Salmonella species: clinical experiences and review of the literature. Braz J Med Biol Res. 2018;51(9):e6864. http://dx.doi.org/10.1590/1414-431x20186864. PMid:29947649.
http://dx.doi.org/10.1590/1414-431x20186...
,88 Deipolyi AR, Czaplicki CD, Oklu R. Inflammatory and infectious aortic diseases. Cardiovasc Diagn Ther. 2018;8(Suppl 1):S61-70. http://dx.doi.org/10.21037/cdt.2017.09.03. PMid:29850419.
http://dx.doi.org/10.21037/cdt.2017.09.0...
,99 Zeng Z, Li Z, Zhao Y, et al. Endovascular repair combined with staged drainage for the treatment of infectious aortic aneurysm: a case report. BMC Cardiovasc Disord. 2020;20(1):406. http://dx.doi.org/10.1186/s12872-020-01694-9. PMid:32894058.
http://dx.doi.org/10.1186/s12872-020-016...
,1111 Wanhainen A, Verzini F, Van Herzeele I, et al. Editor’s Choice - European Society for Vascular Surgery (ESVS) 2019 Clinical Practice Guidelines on the Management of Abdominal Aorto-iliac Artery Aneurysms. Eur J Vasc Endovasc Surg. 2019;57(1):8-93. http://dx.doi.org/10.1016/j.ejvs.2018.09.020. PMid:30528142.
http://dx.doi.org/10.1016/j.ejvs.2018.09...
,1414 Wilson WR, Bower TC, Creager MA, et al. Vascular Graft Infections, Mycotic Aneurysms, and Endovascular Infections: a scientific statement from the American Heart Association. Circulation. 2016;134(20):e412-e460. http://dx.doi.org/10.1161/CIR.0000000000000457. PMid:27737955.
http://dx.doi.org/10.1161/CIR.0000000000...
,1616 Sörelius K, Wanhainen A, Furebring M, et al. Nationwide study of the treatment of mycotic abdominal aortic aneurysms comparing open and endovascular repair. Circulation. 2016;134(23):1822-32. http://dx.doi.org/10.1161/CIRCULATIONAHA.116.024021. PMid:27799273.
http://dx.doi.org/10.1161/CIRCULATIONAHA...

17 Wang TKM, Griffin B, Cremer P, et al. Diagnostic utility of CT and MRI for Mycotic Aneurysms: a meta-analysis. AJR Am J Roentgenol. 2020;215(5):1257-66. http://dx.doi.org/10.2214/AJR.19.22722. PMid:32930605.
http://dx.doi.org/10.2214/AJR.19.22722...
-1818 Watanabe N, Koyama S, Tabira M, et al. Infected aortic aneurysm caused by Streptococcus pyogenes: a case report. J Infect Chemother. 2021;27(4):647-9. http://dx.doi.org/10.1016/j.jiac.2020.11.008. PMid:33277175.
http://dx.doi.org/10.1016/j.jiac.2020.11...
e tendem a acometer homens88 Deipolyi AR, Czaplicki CD, Oklu R. Inflammatory and infectious aortic diseases. Cardiovasc Diagn Ther. 2018;8(Suppl 1):S61-70. http://dx.doi.org/10.21037/cdt.2017.09.03. PMid:29850419.
http://dx.doi.org/10.21037/cdt.2017.09.0...
,1414 Wilson WR, Bower TC, Creager MA, et al. Vascular Graft Infections, Mycotic Aneurysms, and Endovascular Infections: a scientific statement from the American Heart Association. Circulation. 2016;134(20):e412-e460. http://dx.doi.org/10.1161/CIR.0000000000000457. PMid:27737955.
http://dx.doi.org/10.1161/CIR.0000000000...
mais jovens do que aqueles com aneurismas degenerativos44 Kordzadeh A, Watson J, Panayiotopolous YP. Mycotic aneurysm of the superior and inferior mesenteric artery. J Vasc Surg. 2016;63(6):1638-46. http://dx.doi.org/10.1016/j.jvs.2016.01.031. PMid:26951998.
http://dx.doi.org/10.1016/j.jvs.2016.01....
,77 Kano Y, Takamatsu A, Honda H. Mycotic aneurysm due to Pasteurella multocida. QJM. 2020;113(9):667-9. PMid:32016425.,1111 Wanhainen A, Verzini F, Van Herzeele I, et al. Editor’s Choice - European Society for Vascular Surgery (ESVS) 2019 Clinical Practice Guidelines on the Management of Abdominal Aorto-iliac Artery Aneurysms. Eur J Vasc Endovasc Surg. 2019;57(1):8-93. http://dx.doi.org/10.1016/j.ejvs.2018.09.020. PMid:30528142.
http://dx.doi.org/10.1016/j.ejvs.2018.09...
. O crescimento pode ser rápido, com alto risco de ruptura22 Dsouza R, Kota AA, Jain S, Agarwal S. Mycotic abdominal aortic aneurysm complicated by infective spondylitis due to Pseudomonas aeruginosa. BMJ Case Rep. 2020;13(2):1-3. http://dx.doi.org/10.1136/bcr-2019-233461.
http://dx.doi.org/10.1136/bcr-2019-23346...
,44 Kordzadeh A, Watson J, Panayiotopolous YP. Mycotic aneurysm of the superior and inferior mesenteric artery. J Vasc Surg. 2016;63(6):1638-46. http://dx.doi.org/10.1016/j.jvs.2016.01.031. PMid:26951998.
http://dx.doi.org/10.1016/j.jvs.2016.01....
,88 Deipolyi AR, Czaplicki CD, Oklu R. Inflammatory and infectious aortic diseases. Cardiovasc Diagn Ther. 2018;8(Suppl 1):S61-70. http://dx.doi.org/10.21037/cdt.2017.09.03. PMid:29850419.
http://dx.doi.org/10.21037/cdt.2017.09.0...
,99 Zeng Z, Li Z, Zhao Y, et al. Endovascular repair combined with staged drainage for the treatment of infectious aortic aneurysm: a case report. BMC Cardiovasc Disord. 2020;20(1):406. http://dx.doi.org/10.1186/s12872-020-01694-9. PMid:32894058.
http://dx.doi.org/10.1186/s12872-020-016...
,1212 Zhu C, Zhao J, Huang B, Yuan D, Yang Y, Wang T. Long‐term outcome of endovascular aortic repair for mycotic abdominal aortic aneurysm. ANZ J Surg. 2020;90(7-8):1376-80. http://dx.doi.org/10.1111/ans.16122. PMid:32648327.
http://dx.doi.org/10.1111/ans.16122...
,1616 Sörelius K, Wanhainen A, Furebring M, et al. Nationwide study of the treatment of mycotic abdominal aortic aneurysms comparing open and endovascular repair. Circulation. 2016;134(23):1822-32. http://dx.doi.org/10.1161/CIRCULATIONAHA.116.024021. PMid:27799273.
http://dx.doi.org/10.1161/CIRCULATIONAHA...
,1717 Wang TKM, Griffin B, Cremer P, et al. Diagnostic utility of CT and MRI for Mycotic Aneurysms: a meta-analysis. AJR Am J Roentgenol. 2020;215(5):1257-66. http://dx.doi.org/10.2214/AJR.19.22722. PMid:32930605.
http://dx.doi.org/10.2214/AJR.19.22722...
e mortalidade atingindo 60%22 Dsouza R, Kota AA, Jain S, Agarwal S. Mycotic abdominal aortic aneurysm complicated by infective spondylitis due to Pseudomonas aeruginosa. BMJ Case Rep. 2020;13(2):1-3. http://dx.doi.org/10.1136/bcr-2019-233461.
http://dx.doi.org/10.1136/bcr-2019-23346...
. Como agentes etiológicos, já foram descritas bactérias gram-positivas, como Staphylococcus sp22 Dsouza R, Kota AA, Jain S, Agarwal S. Mycotic abdominal aortic aneurysm complicated by infective spondylitis due to Pseudomonas aeruginosa. BMJ Case Rep. 2020;13(2):1-3. http://dx.doi.org/10.1136/bcr-2019-233461.
http://dx.doi.org/10.1136/bcr-2019-23346...
,44 Kordzadeh A, Watson J, Panayiotopolous YP. Mycotic aneurysm of the superior and inferior mesenteric artery. J Vasc Surg. 2016;63(6):1638-46. http://dx.doi.org/10.1016/j.jvs.2016.01.031. PMid:26951998.
http://dx.doi.org/10.1016/j.jvs.2016.01....
,66 Guo Y, Bai Y, Yang C, Wang P, Gu L. Mycotic aneurysm due to Salmonella species: clinical experiences and review of the literature. Braz J Med Biol Res. 2018;51(9):e6864. http://dx.doi.org/10.1590/1414-431x20186864. PMid:29947649.
http://dx.doi.org/10.1590/1414-431x20186...

7 Kano Y, Takamatsu A, Honda H. Mycotic aneurysm due to Pasteurella multocida. QJM. 2020;113(9):667-9. PMid:32016425.
-88 Deipolyi AR, Czaplicki CD, Oklu R. Inflammatory and infectious aortic diseases. Cardiovasc Diagn Ther. 2018;8(Suppl 1):S61-70. http://dx.doi.org/10.21037/cdt.2017.09.03. PMid:29850419.
http://dx.doi.org/10.21037/cdt.2017.09.0...
,1111 Wanhainen A, Verzini F, Van Herzeele I, et al. Editor’s Choice - European Society for Vascular Surgery (ESVS) 2019 Clinical Practice Guidelines on the Management of Abdominal Aorto-iliac Artery Aneurysms. Eur J Vasc Endovasc Surg. 2019;57(1):8-93. http://dx.doi.org/10.1016/j.ejvs.2018.09.020. PMid:30528142.
http://dx.doi.org/10.1016/j.ejvs.2018.09...
,1414 Wilson WR, Bower TC, Creager MA, et al. Vascular Graft Infections, Mycotic Aneurysms, and Endovascular Infections: a scientific statement from the American Heart Association. Circulation. 2016;134(20):e412-e460. http://dx.doi.org/10.1161/CIR.0000000000000457. PMid:27737955.
http://dx.doi.org/10.1161/CIR.0000000000...
,1919 Matsuo T, Mori N, Mizuno A, et al. Infected aortic aneurysm caused by Helicobacter cinaedi: case series and systematic review of the literature. BMC Infect Dis. 2020;20(1):854. http://dx.doi.org/10.1186/s12879-020-05582-7. PMid:33203370.
http://dx.doi.org/10.1186/s12879-020-055...
, Enterococcus sp1111 Wanhainen A, Verzini F, Van Herzeele I, et al. Editor’s Choice - European Society for Vascular Surgery (ESVS) 2019 Clinical Practice Guidelines on the Management of Abdominal Aorto-iliac Artery Aneurysms. Eur J Vasc Endovasc Surg. 2019;57(1):8-93. http://dx.doi.org/10.1016/j.ejvs.2018.09.020. PMid:30528142.
http://dx.doi.org/10.1016/j.ejvs.2018.09...
, Streptococcus sp22 Dsouza R, Kota AA, Jain S, Agarwal S. Mycotic abdominal aortic aneurysm complicated by infective spondylitis due to Pseudomonas aeruginosa. BMJ Case Rep. 2020;13(2):1-3. http://dx.doi.org/10.1136/bcr-2019-233461.
http://dx.doi.org/10.1136/bcr-2019-23346...
,88 Deipolyi AR, Czaplicki CD, Oklu R. Inflammatory and infectious aortic diseases. Cardiovasc Diagn Ther. 2018;8(Suppl 1):S61-70. http://dx.doi.org/10.21037/cdt.2017.09.03. PMid:29850419.
http://dx.doi.org/10.21037/cdt.2017.09.0...
,1111 Wanhainen A, Verzini F, Van Herzeele I, et al. Editor’s Choice - European Society for Vascular Surgery (ESVS) 2019 Clinical Practice Guidelines on the Management of Abdominal Aorto-iliac Artery Aneurysms. Eur J Vasc Endovasc Surg. 2019;57(1):8-93. http://dx.doi.org/10.1016/j.ejvs.2018.09.020. PMid:30528142.
http://dx.doi.org/10.1016/j.ejvs.2018.09...
,1818 Watanabe N, Koyama S, Tabira M, et al. Infected aortic aneurysm caused by Streptococcus pyogenes: a case report. J Infect Chemother. 2021;27(4):647-9. http://dx.doi.org/10.1016/j.jiac.2020.11.008. PMid:33277175.
http://dx.doi.org/10.1016/j.jiac.2020.11...
,1919 Matsuo T, Mori N, Mizuno A, et al. Infected aortic aneurysm caused by Helicobacter cinaedi: case series and systematic review of the literature. BMC Infect Dis. 2020;20(1):854. http://dx.doi.org/10.1186/s12879-020-05582-7. PMid:33203370.
http://dx.doi.org/10.1186/s12879-020-055...
e Clostridium sp1111 Wanhainen A, Verzini F, Van Herzeele I, et al. Editor’s Choice - European Society for Vascular Surgery (ESVS) 2019 Clinical Practice Guidelines on the Management of Abdominal Aorto-iliac Artery Aneurysms. Eur J Vasc Endovasc Surg. 2019;57(1):8-93. http://dx.doi.org/10.1016/j.ejvs.2018.09.020. PMid:30528142.
http://dx.doi.org/10.1016/j.ejvs.2018.09...
, e gram-negativas, como Salmonella sp22 Dsouza R, Kota AA, Jain S, Agarwal S. Mycotic abdominal aortic aneurysm complicated by infective spondylitis due to Pseudomonas aeruginosa. BMJ Case Rep. 2020;13(2):1-3. http://dx.doi.org/10.1136/bcr-2019-233461.
http://dx.doi.org/10.1136/bcr-2019-23346...

3 Nagrodzki J, Sharrocks KE, Wong VK, Carmichael AJ. A mycotic aneurysm related to Salmonella Rissen infection: a case report. BMC Infect Dis. 2020;20(1):97. http://dx.doi.org/10.1186/s12879-020-4819-0. PMid:32005105.
http://dx.doi.org/10.1186/s12879-020-481...
-44 Kordzadeh A, Watson J, Panayiotopolous YP. Mycotic aneurysm of the superior and inferior mesenteric artery. J Vasc Surg. 2016;63(6):1638-46. http://dx.doi.org/10.1016/j.jvs.2016.01.031. PMid:26951998.
http://dx.doi.org/10.1016/j.jvs.2016.01....
,66 Guo Y, Bai Y, Yang C, Wang P, Gu L. Mycotic aneurysm due to Salmonella species: clinical experiences and review of the literature. Braz J Med Biol Res. 2018;51(9):e6864. http://dx.doi.org/10.1590/1414-431x20186864. PMid:29947649.
http://dx.doi.org/10.1590/1414-431x20186...

7 Kano Y, Takamatsu A, Honda H. Mycotic aneurysm due to Pasteurella multocida. QJM. 2020;113(9):667-9. PMid:32016425.
-88 Deipolyi AR, Czaplicki CD, Oklu R. Inflammatory and infectious aortic diseases. Cardiovasc Diagn Ther. 2018;8(Suppl 1):S61-70. http://dx.doi.org/10.21037/cdt.2017.09.03. PMid:29850419.
http://dx.doi.org/10.21037/cdt.2017.09.0...
,1111 Wanhainen A, Verzini F, Van Herzeele I, et al. Editor’s Choice - European Society for Vascular Surgery (ESVS) 2019 Clinical Practice Guidelines on the Management of Abdominal Aorto-iliac Artery Aneurysms. Eur J Vasc Endovasc Surg. 2019;57(1):8-93. http://dx.doi.org/10.1016/j.ejvs.2018.09.020. PMid:30528142.
http://dx.doi.org/10.1016/j.ejvs.2018.09...
,1414 Wilson WR, Bower TC, Creager MA, et al. Vascular Graft Infections, Mycotic Aneurysms, and Endovascular Infections: a scientific statement from the American Heart Association. Circulation. 2016;134(20):e412-e460. http://dx.doi.org/10.1161/CIR.0000000000000457. PMid:27737955.
http://dx.doi.org/10.1161/CIR.0000000000...
, Pasteurella sp77 Kano Y, Takamatsu A, Honda H. Mycotic aneurysm due to Pasteurella multocida. QJM. 2020;113(9):667-9. PMid:32016425., Brucella sp2020 Alhaizaey A, Alassiri M, Alghamdi M, Alsharani M. Mycotic aortic aneurysm due to brucellosis. J Vasc Surg Cases Innov Tech. 2016;2(2):50-2. http://dx.doi.org/10.1016/j.jvsc.2016.03.009. PMid:31193364.
http://dx.doi.org/10.1016/j.jvsc.2016.03...
, Coxiella burnetti1111 Wanhainen A, Verzini F, Van Herzeele I, et al. Editor’s Choice - European Society for Vascular Surgery (ESVS) 2019 Clinical Practice Guidelines on the Management of Abdominal Aorto-iliac Artery Aneurysms. Eur J Vasc Endovasc Surg. 2019;57(1):8-93. http://dx.doi.org/10.1016/j.ejvs.2018.09.020. PMid:30528142.
http://dx.doi.org/10.1016/j.ejvs.2018.09...
e Pseudomonas aeruginosa22 Dsouza R, Kota AA, Jain S, Agarwal S. Mycotic abdominal aortic aneurysm complicated by infective spondylitis due to Pseudomonas aeruginosa. BMJ Case Rep. 2020;13(2):1-3. http://dx.doi.org/10.1136/bcr-2019-233461.
http://dx.doi.org/10.1136/bcr-2019-23346...
,1919 Matsuo T, Mori N, Mizuno A, et al. Infected aortic aneurysm caused by Helicobacter cinaedi: case series and systematic review of the literature. BMC Infect Dis. 2020;20(1):854. http://dx.doi.org/10.1186/s12879-020-05582-7. PMid:33203370.
http://dx.doi.org/10.1186/s12879-020-055...
, além de fungos55 Sörelius K, di Summa PG. On the diagnosis of mycotic aortic aneurysms. Clin Med Insights Cardiol. 2018;12:1179546818759678. http://dx.doi.org/10.1177/1179546818759678. PMid:29497343.
http://dx.doi.org/10.1177/11795468187596...
,1111 Wanhainen A, Verzini F, Van Herzeele I, et al. Editor’s Choice - European Society for Vascular Surgery (ESVS) 2019 Clinical Practice Guidelines on the Management of Abdominal Aorto-iliac Artery Aneurysms. Eur J Vasc Endovasc Surg. 2019;57(1):8-93. http://dx.doi.org/10.1016/j.ejvs.2018.09.020. PMid:30528142.
http://dx.doi.org/10.1016/j.ejvs.2018.09...
,1818 Watanabe N, Koyama S, Tabira M, et al. Infected aortic aneurysm caused by Streptococcus pyogenes: a case report. J Infect Chemother. 2021;27(4):647-9. http://dx.doi.org/10.1016/j.jiac.2020.11.008. PMid:33277175.
http://dx.doi.org/10.1016/j.jiac.2020.11...
. Os agentes mais frequentemente identificados pertencem aos gêneros Staphylococcus sp e Salmonella sp66 Guo Y, Bai Y, Yang C, Wang P, Gu L. Mycotic aneurysm due to Salmonella species: clinical experiences and review of the literature. Braz J Med Biol Res. 2018;51(9):e6864. http://dx.doi.org/10.1590/1414-431x20186864. PMid:29947649.
http://dx.doi.org/10.1590/1414-431x20186...
,1212 Zhu C, Zhao J, Huang B, Yuan D, Yang Y, Wang T. Long‐term outcome of endovascular aortic repair for mycotic abdominal aortic aneurysm. ANZ J Surg. 2020;90(7-8):1376-80. http://dx.doi.org/10.1111/ans.16122. PMid:32648327.
http://dx.doi.org/10.1111/ans.16122...
,1818 Watanabe N, Koyama S, Tabira M, et al. Infected aortic aneurysm caused by Streptococcus pyogenes: a case report. J Infect Chemother. 2021;27(4):647-9. http://dx.doi.org/10.1016/j.jiac.2020.11.008. PMid:33277175.
http://dx.doi.org/10.1016/j.jiac.2020.11...
. A fonte da infecção não é localizada em 1/3 dos casos, e o agente etiológico não é estabelecido em 20-40% dos casos1111 Wanhainen A, Verzini F, Van Herzeele I, et al. Editor’s Choice - European Society for Vascular Surgery (ESVS) 2019 Clinical Practice Guidelines on the Management of Abdominal Aorto-iliac Artery Aneurysms. Eur J Vasc Endovasc Surg. 2019;57(1):8-93. http://dx.doi.org/10.1016/j.ejvs.2018.09.020. PMid:30528142.
http://dx.doi.org/10.1016/j.ejvs.2018.09...
,1414 Wilson WR, Bower TC, Creager MA, et al. Vascular Graft Infections, Mycotic Aneurysms, and Endovascular Infections: a scientific statement from the American Heart Association. Circulation. 2016;134(20):e412-e460. http://dx.doi.org/10.1161/CIR.0000000000000457. PMid:27737955.
http://dx.doi.org/10.1161/CIR.0000000000...
,1515 Dang Q, Van Eps RG, Wever JJ, et al. Nationwide study of the treatment of mycotic abdominal aortic aneurysms comparing open and endovascular repair in The Netherlands. J Vasc Surg. 2020;72(2):531-40. http://dx.doi.org/10.1016/j.jvs.2019.09.060. PMid:32061482.
http://dx.doi.org/10.1016/j.jvs.2019.09....
. Aneurismas infecciosos ocorrem por contiguidade2121 Patel AP, Cantos A, Butani D. Mycotic Aneurysm of the Hepatic Artery: a case report and its management. J Clin Imaging Sci. 2020;10:41. http://dx.doi.org/10.25259/JCIS_89_2020. PMid:32754376.
http://dx.doi.org/10.25259/JCIS_89_2020...
ou, frequentemente, por bacteremia11 Hurtado DFG, Neira JCH, Atala SH, Lawrence PT. Manejo de un aneurisma infeccioso. Rev Cir. 2019;71(5):446-9.,22 Dsouza R, Kota AA, Jain S, Agarwal S. Mycotic abdominal aortic aneurysm complicated by infective spondylitis due to Pseudomonas aeruginosa. BMJ Case Rep. 2020;13(2):1-3. http://dx.doi.org/10.1136/bcr-2019-233461.
http://dx.doi.org/10.1136/bcr-2019-23346...
,55 Sörelius K, di Summa PG. On the diagnosis of mycotic aortic aneurysms. Clin Med Insights Cardiol. 2018;12:1179546818759678. http://dx.doi.org/10.1177/1179546818759678. PMid:29497343.
http://dx.doi.org/10.1177/11795468187596...
,1111 Wanhainen A, Verzini F, Van Herzeele I, et al. Editor’s Choice - European Society for Vascular Surgery (ESVS) 2019 Clinical Practice Guidelines on the Management of Abdominal Aorto-iliac Artery Aneurysms. Eur J Vasc Endovasc Surg. 2019;57(1):8-93. http://dx.doi.org/10.1016/j.ejvs.2018.09.020. PMid:30528142.
http://dx.doi.org/10.1016/j.ejvs.2018.09...
,1414 Wilson WR, Bower TC, Creager MA, et al. Vascular Graft Infections, Mycotic Aneurysms, and Endovascular Infections: a scientific statement from the American Heart Association. Circulation. 2016;134(20):e412-e460. http://dx.doi.org/10.1161/CIR.0000000000000457. PMid:27737955.
http://dx.doi.org/10.1161/CIR.0000000000...
,1717 Wang TKM, Griffin B, Cremer P, et al. Diagnostic utility of CT and MRI for Mycotic Aneurysms: a meta-analysis. AJR Am J Roentgenol. 2020;215(5):1257-66. http://dx.doi.org/10.2214/AJR.19.22722. PMid:32930605.
http://dx.doi.org/10.2214/AJR.19.22722...
,1919 Matsuo T, Mori N, Mizuno A, et al. Infected aortic aneurysm caused by Helicobacter cinaedi: case series and systematic review of the literature. BMC Infect Dis. 2020;20(1):854. http://dx.doi.org/10.1186/s12879-020-05582-7. PMid:33203370.
http://dx.doi.org/10.1186/s12879-020-055...
. Após se fixar à parede arterial, o microrganismo gera inflamação aguda com infiltração neutrofílica, que leva à ativação de enzimas e ao enfraquecimento parietal88 Deipolyi AR, Czaplicki CD, Oklu R. Inflammatory and infectious aortic diseases. Cardiovasc Diagn Ther. 2018;8(Suppl 1):S61-70. http://dx.doi.org/10.21037/cdt.2017.09.03. PMid:29850419.
http://dx.doi.org/10.21037/cdt.2017.09.0...
e resulta em supuração e dilatação arterial11 Hurtado DFG, Neira JCH, Atala SH, Lawrence PT. Manejo de un aneurisma infeccioso. Rev Cir. 2019;71(5):446-9.,22 Dsouza R, Kota AA, Jain S, Agarwal S. Mycotic abdominal aortic aneurysm complicated by infective spondylitis due to Pseudomonas aeruginosa. BMJ Case Rep. 2020;13(2):1-3. http://dx.doi.org/10.1136/bcr-2019-233461.
http://dx.doi.org/10.1136/bcr-2019-23346...
,55 Sörelius K, di Summa PG. On the diagnosis of mycotic aortic aneurysms. Clin Med Insights Cardiol. 2018;12:1179546818759678. http://dx.doi.org/10.1177/1179546818759678. PMid:29497343.
http://dx.doi.org/10.1177/11795468187596...
,99 Zeng Z, Li Z, Zhao Y, et al. Endovascular repair combined with staged drainage for the treatment of infectious aortic aneurysm: a case report. BMC Cardiovasc Disord. 2020;20(1):406. http://dx.doi.org/10.1186/s12872-020-01694-9. PMid:32894058.
http://dx.doi.org/10.1186/s12872-020-016...
,1111 Wanhainen A, Verzini F, Van Herzeele I, et al. Editor’s Choice - European Society for Vascular Surgery (ESVS) 2019 Clinical Practice Guidelines on the Management of Abdominal Aorto-iliac Artery Aneurysms. Eur J Vasc Endovasc Surg. 2019;57(1):8-93. http://dx.doi.org/10.1016/j.ejvs.2018.09.020. PMid:30528142.
http://dx.doi.org/10.1016/j.ejvs.2018.09...
,1717 Wang TKM, Griffin B, Cremer P, et al. Diagnostic utility of CT and MRI for Mycotic Aneurysms: a meta-analysis. AJR Am J Roentgenol. 2020;215(5):1257-66. http://dx.doi.org/10.2214/AJR.19.22722. PMid:32930605.
http://dx.doi.org/10.2214/AJR.19.22722...
,2020 Alhaizaey A, Alassiri M, Alghamdi M, Alsharani M. Mycotic aortic aneurysm due to brucellosis. J Vasc Surg Cases Innov Tech. 2016;2(2):50-2. http://dx.doi.org/10.1016/j.jvsc.2016.03.009. PMid:31193364.
http://dx.doi.org/10.1016/j.jvsc.2016.03...
,2222 Tshomba Y, Sica S, Minelli F, et al. Management of mycotic aorto-iliac aneurysms: a 30-year monocentric experience. Eur Rev Med Pharmacol Sci. 2020;24(6):3274-81. PMid:32271445.. O acometimento mais comum da aorta se deve ao vasa vasorum mais pronunciado em artérias mais calibrosas, o que favorece colonização bacteriana88 Deipolyi AR, Czaplicki CD, Oklu R. Inflammatory and infectious aortic diseases. Cardiovasc Diagn Ther. 2018;8(Suppl 1):S61-70. http://dx.doi.org/10.21037/cdt.2017.09.03. PMid:29850419.
http://dx.doi.org/10.21037/cdt.2017.09.0...
,1111 Wanhainen A, Verzini F, Van Herzeele I, et al. Editor’s Choice - European Society for Vascular Surgery (ESVS) 2019 Clinical Practice Guidelines on the Management of Abdominal Aorto-iliac Artery Aneurysms. Eur J Vasc Endovasc Surg. 2019;57(1):8-93. http://dx.doi.org/10.1016/j.ejvs.2018.09.020. PMid:30528142.
http://dx.doi.org/10.1016/j.ejvs.2018.09...
,1414 Wilson WR, Bower TC, Creager MA, et al. Vascular Graft Infections, Mycotic Aneurysms, and Endovascular Infections: a scientific statement from the American Heart Association. Circulation. 2016;134(20):e412-e460. http://dx.doi.org/10.1161/CIR.0000000000000457. PMid:27737955.
http://dx.doi.org/10.1161/CIR.0000000000...
,1919 Matsuo T, Mori N, Mizuno A, et al. Infected aortic aneurysm caused by Helicobacter cinaedi: case series and systematic review of the literature. BMC Infect Dis. 2020;20(1):854. http://dx.doi.org/10.1186/s12879-020-05582-7. PMid:33203370.
http://dx.doi.org/10.1186/s12879-020-055...
.

Diagnóstico precoce é a chave para o sucesso terapêutico66 Guo Y, Bai Y, Yang C, Wang P, Gu L. Mycotic aneurysm due to Salmonella species: clinical experiences and review of the literature. Braz J Med Biol Res. 2018;51(9):e6864. http://dx.doi.org/10.1590/1414-431x20186864. PMid:29947649.
http://dx.doi.org/10.1590/1414-431x20186...
,88 Deipolyi AR, Czaplicki CD, Oklu R. Inflammatory and infectious aortic diseases. Cardiovasc Diagn Ther. 2018;8(Suppl 1):S61-70. http://dx.doi.org/10.21037/cdt.2017.09.03. PMid:29850419.
http://dx.doi.org/10.21037/cdt.2017.09.0...
,99 Zeng Z, Li Z, Zhao Y, et al. Endovascular repair combined with staged drainage for the treatment of infectious aortic aneurysm: a case report. BMC Cardiovasc Disord. 2020;20(1):406. http://dx.doi.org/10.1186/s12872-020-01694-9. PMid:32894058.
http://dx.doi.org/10.1186/s12872-020-016...
,1212 Zhu C, Zhao J, Huang B, Yuan D, Yang Y, Wang T. Long‐term outcome of endovascular aortic repair for mycotic abdominal aortic aneurysm. ANZ J Surg. 2020;90(7-8):1376-80. http://dx.doi.org/10.1111/ans.16122. PMid:32648327.
http://dx.doi.org/10.1111/ans.16122...
,1616 Sörelius K, Wanhainen A, Furebring M, et al. Nationwide study of the treatment of mycotic abdominal aortic aneurysms comparing open and endovascular repair. Circulation. 2016;134(23):1822-32. http://dx.doi.org/10.1161/CIRCULATIONAHA.116.024021. PMid:27799273.
http://dx.doi.org/10.1161/CIRCULATIONAHA...
. Classicamente, há febre11 Hurtado DFG, Neira JCH, Atala SH, Lawrence PT. Manejo de un aneurisma infeccioso. Rev Cir. 2019;71(5):446-9.,33 Nagrodzki J, Sharrocks KE, Wong VK, Carmichael AJ. A mycotic aneurysm related to Salmonella Rissen infection: a case report. BMC Infect Dis. 2020;20(1):97. http://dx.doi.org/10.1186/s12879-020-4819-0. PMid:32005105.
http://dx.doi.org/10.1186/s12879-020-481...
,44 Kordzadeh A, Watson J, Panayiotopolous YP. Mycotic aneurysm of the superior and inferior mesenteric artery. J Vasc Surg. 2016;63(6):1638-46. http://dx.doi.org/10.1016/j.jvs.2016.01.031. PMid:26951998.
http://dx.doi.org/10.1016/j.jvs.2016.01....
,66 Guo Y, Bai Y, Yang C, Wang P, Gu L. Mycotic aneurysm due to Salmonella species: clinical experiences and review of the literature. Braz J Med Biol Res. 2018;51(9):e6864. http://dx.doi.org/10.1590/1414-431x20186864. PMid:29947649.
http://dx.doi.org/10.1590/1414-431x20186...

7 Kano Y, Takamatsu A, Honda H. Mycotic aneurysm due to Pasteurella multocida. QJM. 2020;113(9):667-9. PMid:32016425.
-88 Deipolyi AR, Czaplicki CD, Oklu R. Inflammatory and infectious aortic diseases. Cardiovasc Diagn Ther. 2018;8(Suppl 1):S61-70. http://dx.doi.org/10.21037/cdt.2017.09.03. PMid:29850419.
http://dx.doi.org/10.21037/cdt.2017.09.0...
,1414 Wilson WR, Bower TC, Creager MA, et al. Vascular Graft Infections, Mycotic Aneurysms, and Endovascular Infections: a scientific statement from the American Heart Association. Circulation. 2016;134(20):e412-e460. http://dx.doi.org/10.1161/CIR.0000000000000457. PMid:27737955.
http://dx.doi.org/10.1161/CIR.0000000000...
,1818 Watanabe N, Koyama S, Tabira M, et al. Infected aortic aneurysm caused by Streptococcus pyogenes: a case report. J Infect Chemother. 2021;27(4):647-9. http://dx.doi.org/10.1016/j.jiac.2020.11.008. PMid:33277175.
http://dx.doi.org/10.1016/j.jiac.2020.11...
, dor abdominal/lombar e massa pulsátil11 Hurtado DFG, Neira JCH, Atala SH, Lawrence PT. Manejo de un aneurisma infeccioso. Rev Cir. 2019;71(5):446-9.,44 Kordzadeh A, Watson J, Panayiotopolous YP. Mycotic aneurysm of the superior and inferior mesenteric artery. J Vasc Surg. 2016;63(6):1638-46. http://dx.doi.org/10.1016/j.jvs.2016.01.031. PMid:26951998.
http://dx.doi.org/10.1016/j.jvs.2016.01....
,66 Guo Y, Bai Y, Yang C, Wang P, Gu L. Mycotic aneurysm due to Salmonella species: clinical experiences and review of the literature. Braz J Med Biol Res. 2018;51(9):e6864. http://dx.doi.org/10.1590/1414-431x20186864. PMid:29947649.
http://dx.doi.org/10.1590/1414-431x20186...

7 Kano Y, Takamatsu A, Honda H. Mycotic aneurysm due to Pasteurella multocida. QJM. 2020;113(9):667-9. PMid:32016425.
-88 Deipolyi AR, Czaplicki CD, Oklu R. Inflammatory and infectious aortic diseases. Cardiovasc Diagn Ther. 2018;8(Suppl 1):S61-70. http://dx.doi.org/10.21037/cdt.2017.09.03. PMid:29850419.
http://dx.doi.org/10.21037/cdt.2017.09.0...
,1414 Wilson WR, Bower TC, Creager MA, et al. Vascular Graft Infections, Mycotic Aneurysms, and Endovascular Infections: a scientific statement from the American Heart Association. Circulation. 2016;134(20):e412-e460. http://dx.doi.org/10.1161/CIR.0000000000000457. PMid:27737955.
http://dx.doi.org/10.1161/CIR.0000000000...
,1818 Watanabe N, Koyama S, Tabira M, et al. Infected aortic aneurysm caused by Streptococcus pyogenes: a case report. J Infect Chemother. 2021;27(4):647-9. http://dx.doi.org/10.1016/j.jiac.2020.11.008. PMid:33277175.
http://dx.doi.org/10.1016/j.jiac.2020.11...
na vigência de um quadro infeccioso (osteomielite, infecções do trato urinário, tuberculose, gastroenterite e infecções de partes moles)11 Hurtado DFG, Neira JCH, Atala SH, Lawrence PT. Manejo de un aneurisma infeccioso. Rev Cir. 2019;71(5):446-9.,44 Kordzadeh A, Watson J, Panayiotopolous YP. Mycotic aneurysm of the superior and inferior mesenteric artery. J Vasc Surg. 2016;63(6):1638-46. http://dx.doi.org/10.1016/j.jvs.2016.01.031. PMid:26951998.
http://dx.doi.org/10.1016/j.jvs.2016.01....
,66 Guo Y, Bai Y, Yang C, Wang P, Gu L. Mycotic aneurysm due to Salmonella species: clinical experiences and review of the literature. Braz J Med Biol Res. 2018;51(9):e6864. http://dx.doi.org/10.1590/1414-431x20186864. PMid:29947649.
http://dx.doi.org/10.1590/1414-431x20186...
,1111 Wanhainen A, Verzini F, Van Herzeele I, et al. Editor’s Choice - European Society for Vascular Surgery (ESVS) 2019 Clinical Practice Guidelines on the Management of Abdominal Aorto-iliac Artery Aneurysms. Eur J Vasc Endovasc Surg. 2019;57(1):8-93. http://dx.doi.org/10.1016/j.ejvs.2018.09.020. PMid:30528142.
http://dx.doi.org/10.1016/j.ejvs.2018.09...
,1414 Wilson WR, Bower TC, Creager MA, et al. Vascular Graft Infections, Mycotic Aneurysms, and Endovascular Infections: a scientific statement from the American Heart Association. Circulation. 2016;134(20):e412-e460. http://dx.doi.org/10.1161/CIR.0000000000000457. PMid:27737955.
http://dx.doi.org/10.1161/CIR.0000000000...
e quadros de imunossupressão por doenças ou medicamentos (câncer, insuficiência renal dialítica, HIV, diabetes, corticoides). Todavia, também existem casos assintomáticos44 Kordzadeh A, Watson J, Panayiotopolous YP. Mycotic aneurysm of the superior and inferior mesenteric artery. J Vasc Surg. 2016;63(6):1638-46. http://dx.doi.org/10.1016/j.jvs.2016.01.031. PMid:26951998.
http://dx.doi.org/10.1016/j.jvs.2016.01....
,1414 Wilson WR, Bower TC, Creager MA, et al. Vascular Graft Infections, Mycotic Aneurysms, and Endovascular Infections: a scientific statement from the American Heart Association. Circulation. 2016;134(20):e412-e460. http://dx.doi.org/10.1161/CIR.0000000000000457. PMid:27737955.
http://dx.doi.org/10.1161/CIR.0000000000...
. Nos três casos relatados, houve dor abdominal; nos casos 1 e 2, havia antecedentes de quadro infeccioso, e no caso 1 também se identificou uso de medicamento imunossupressor. Exames laboratoriais geralmente mostram leucocitose11 Hurtado DFG, Neira JCH, Atala SH, Lawrence PT. Manejo de un aneurisma infeccioso. Rev Cir. 2019;71(5):446-9.,66 Guo Y, Bai Y, Yang C, Wang P, Gu L. Mycotic aneurysm due to Salmonella species: clinical experiences and review of the literature. Braz J Med Biol Res. 2018;51(9):e6864. http://dx.doi.org/10.1590/1414-431x20186864. PMid:29947649.
http://dx.doi.org/10.1590/1414-431x20186...
,88 Deipolyi AR, Czaplicki CD, Oklu R. Inflammatory and infectious aortic diseases. Cardiovasc Diagn Ther. 2018;8(Suppl 1):S61-70. http://dx.doi.org/10.21037/cdt.2017.09.03. PMid:29850419.
http://dx.doi.org/10.21037/cdt.2017.09.0...
,1111 Wanhainen A, Verzini F, Van Herzeele I, et al. Editor’s Choice - European Society for Vascular Surgery (ESVS) 2019 Clinical Practice Guidelines on the Management of Abdominal Aorto-iliac Artery Aneurysms. Eur J Vasc Endovasc Surg. 2019;57(1):8-93. http://dx.doi.org/10.1016/j.ejvs.2018.09.020. PMid:30528142.
http://dx.doi.org/10.1016/j.ejvs.2018.09...
,1212 Zhu C, Zhao J, Huang B, Yuan D, Yang Y, Wang T. Long‐term outcome of endovascular aortic repair for mycotic abdominal aortic aneurysm. ANZ J Surg. 2020;90(7-8):1376-80. http://dx.doi.org/10.1111/ans.16122. PMid:32648327.
http://dx.doi.org/10.1111/ans.16122...
,1414 Wilson WR, Bower TC, Creager MA, et al. Vascular Graft Infections, Mycotic Aneurysms, and Endovascular Infections: a scientific statement from the American Heart Association. Circulation. 2016;134(20):e412-e460. http://dx.doi.org/10.1161/CIR.0000000000000457. PMid:27737955.
http://dx.doi.org/10.1161/CIR.0000000000...
e marcadores inflamatórios, como VHS e PCR, elevadas66 Guo Y, Bai Y, Yang C, Wang P, Gu L. Mycotic aneurysm due to Salmonella species: clinical experiences and review of the literature. Braz J Med Biol Res. 2018;51(9):e6864. http://dx.doi.org/10.1590/1414-431x20186864. PMid:29947649.
http://dx.doi.org/10.1590/1414-431x20186...
,1212 Zhu C, Zhao J, Huang B, Yuan D, Yang Y, Wang T. Long‐term outcome of endovascular aortic repair for mycotic abdominal aortic aneurysm. ANZ J Surg. 2020;90(7-8):1376-80. http://dx.doi.org/10.1111/ans.16122. PMid:32648327.
http://dx.doi.org/10.1111/ans.16122...
, além de hemoculturas positivas11 Hurtado DFG, Neira JCH, Atala SH, Lawrence PT. Manejo de un aneurisma infeccioso. Rev Cir. 2019;71(5):446-9.,33 Nagrodzki J, Sharrocks KE, Wong VK, Carmichael AJ. A mycotic aneurysm related to Salmonella Rissen infection: a case report. BMC Infect Dis. 2020;20(1):97. http://dx.doi.org/10.1186/s12879-020-4819-0. PMid:32005105.
http://dx.doi.org/10.1186/s12879-020-481...
,44 Kordzadeh A, Watson J, Panayiotopolous YP. Mycotic aneurysm of the superior and inferior mesenteric artery. J Vasc Surg. 2016;63(6):1638-46. http://dx.doi.org/10.1016/j.jvs.2016.01.031. PMid:26951998.
http://dx.doi.org/10.1016/j.jvs.2016.01....
,66 Guo Y, Bai Y, Yang C, Wang P, Gu L. Mycotic aneurysm due to Salmonella species: clinical experiences and review of the literature. Braz J Med Biol Res. 2018;51(9):e6864. http://dx.doi.org/10.1590/1414-431x20186864. PMid:29947649.
http://dx.doi.org/10.1590/1414-431x20186...
,77 Kano Y, Takamatsu A, Honda H. Mycotic aneurysm due to Pasteurella multocida. QJM. 2020;113(9):667-9. PMid:32016425.,1616 Sörelius K, Wanhainen A, Furebring M, et al. Nationwide study of the treatment of mycotic abdominal aortic aneurysms comparing open and endovascular repair. Circulation. 2016;134(23):1822-32. http://dx.doi.org/10.1161/CIRCULATIONAHA.116.024021. PMid:27799273.
http://dx.doi.org/10.1161/CIRCULATIONAHA...
. Mesmo na fase aguda, a hemocultura pode ser negativa em até 50% dos casos1414 Wilson WR, Bower TC, Creager MA, et al. Vascular Graft Infections, Mycotic Aneurysms, and Endovascular Infections: a scientific statement from the American Heart Association. Circulation. 2016;134(20):e412-e460. http://dx.doi.org/10.1161/CIR.0000000000000457. PMid:27737955.
http://dx.doi.org/10.1161/CIR.0000000000...
,2323 Kazuno K, Kinoshita H, Hori M, et al. Endovascular treatment for mycotic aneurysm using pyoktanin- applied devices. Cvir Endovascular. 2020;3(1):1-8. http://dx.doi.org/10.1186/s42155-020-00151-0. PMid:32886250.
http://dx.doi.org/10.1186/s42155-020-001...
, principalmente se o paciente estiver recebendo antibióticos, o que é comum88 Deipolyi AR, Czaplicki CD, Oklu R. Inflammatory and infectious aortic diseases. Cardiovasc Diagn Ther. 2018;8(Suppl 1):S61-70. http://dx.doi.org/10.21037/cdt.2017.09.03. PMid:29850419.
http://dx.doi.org/10.21037/cdt.2017.09.0...
,1414 Wilson WR, Bower TC, Creager MA, et al. Vascular Graft Infections, Mycotic Aneurysms, and Endovascular Infections: a scientific statement from the American Heart Association. Circulation. 2016;134(20):e412-e460. http://dx.doi.org/10.1161/CIR.0000000000000457. PMid:27737955.
http://dx.doi.org/10.1161/CIR.0000000000...
,1515 Dang Q, Van Eps RG, Wever JJ, et al. Nationwide study of the treatment of mycotic abdominal aortic aneurysms comparing open and endovascular repair in The Netherlands. J Vasc Surg. 2020;72(2):531-40. http://dx.doi.org/10.1016/j.jvs.2019.09.060. PMid:32061482.
http://dx.doi.org/10.1016/j.jvs.2019.09....
. Na presente série, dois casos apresentaram hemoculturas positivas. Na angiotomografia, irregularidades parietais, dilatações saculares, alterações sugestivas de inflamação, massa/coleção líquida perivascular, formação de gás periaórtico, sinais de rotura livre ou contida e progressão rápida em exames seriados são frequentemente encontrados11 Hurtado DFG, Neira JCH, Atala SH, Lawrence PT. Manejo de un aneurisma infeccioso. Rev Cir. 2019;71(5):446-9.,44 Kordzadeh A, Watson J, Panayiotopolous YP. Mycotic aneurysm of the superior and inferior mesenteric artery. J Vasc Surg. 2016;63(6):1638-46. http://dx.doi.org/10.1016/j.jvs.2016.01.031. PMid:26951998.
http://dx.doi.org/10.1016/j.jvs.2016.01....
,55 Sörelius K, di Summa PG. On the diagnosis of mycotic aortic aneurysms. Clin Med Insights Cardiol. 2018;12:1179546818759678. http://dx.doi.org/10.1177/1179546818759678. PMid:29497343.
http://dx.doi.org/10.1177/11795468187596...
,88 Deipolyi AR, Czaplicki CD, Oklu R. Inflammatory and infectious aortic diseases. Cardiovasc Diagn Ther. 2018;8(Suppl 1):S61-70. http://dx.doi.org/10.21037/cdt.2017.09.03. PMid:29850419.
http://dx.doi.org/10.21037/cdt.2017.09.0...
,99 Zeng Z, Li Z, Zhao Y, et al. Endovascular repair combined with staged drainage for the treatment of infectious aortic aneurysm: a case report. BMC Cardiovasc Disord. 2020;20(1):406. http://dx.doi.org/10.1186/s12872-020-01694-9. PMid:32894058.
http://dx.doi.org/10.1186/s12872-020-016...
,1111 Wanhainen A, Verzini F, Van Herzeele I, et al. Editor’s Choice - European Society for Vascular Surgery (ESVS) 2019 Clinical Practice Guidelines on the Management of Abdominal Aorto-iliac Artery Aneurysms. Eur J Vasc Endovasc Surg. 2019;57(1):8-93. http://dx.doi.org/10.1016/j.ejvs.2018.09.020. PMid:30528142.
http://dx.doi.org/10.1016/j.ejvs.2018.09...
,1212 Zhu C, Zhao J, Huang B, Yuan D, Yang Y, Wang T. Long‐term outcome of endovascular aortic repair for mycotic abdominal aortic aneurysm. ANZ J Surg. 2020;90(7-8):1376-80. http://dx.doi.org/10.1111/ans.16122. PMid:32648327.
http://dx.doi.org/10.1111/ans.16122...
,1414 Wilson WR, Bower TC, Creager MA, et al. Vascular Graft Infections, Mycotic Aneurysms, and Endovascular Infections: a scientific statement from the American Heart Association. Circulation. 2016;134(20):e412-e460. http://dx.doi.org/10.1161/CIR.0000000000000457. PMid:27737955.
http://dx.doi.org/10.1161/CIR.0000000000...
,1717 Wang TKM, Griffin B, Cremer P, et al. Diagnostic utility of CT and MRI for Mycotic Aneurysms: a meta-analysis. AJR Am J Roentgenol. 2020;215(5):1257-66. http://dx.doi.org/10.2214/AJR.19.22722. PMid:32930605.
http://dx.doi.org/10.2214/AJR.19.22722...
,2424 Husmann L, Huellner MW, Ledergerber B, et al. Diagnostic accuracy of PET/CT and contrast enhanced CT in patients with suspected infected aortic aneurysms. Eur J Vasc Endovasc Surg. 2020;59(6):972-81. http://dx.doi.org/10.1016/j.ejvs.2020.01.032. PMid:32340877.
http://dx.doi.org/10.1016/j.ejvs.2020.01...
. Na tomografia, abscessos hepáticos e esplênicos devem ser pesquisados99 Zeng Z, Li Z, Zhao Y, et al. Endovascular repair combined with staged drainage for the treatment of infectious aortic aneurysm: a case report. BMC Cardiovasc Disord. 2020;20(1):406. http://dx.doi.org/10.1186/s12872-020-01694-9. PMid:32894058.
http://dx.doi.org/10.1186/s12872-020-016...
,2121 Patel AP, Cantos A, Butani D. Mycotic Aneurysm of the Hepatic Artery: a case report and its management. J Clin Imaging Sci. 2020;10:41. http://dx.doi.org/10.25259/JCIS_89_2020. PMid:32754376.
http://dx.doi.org/10.25259/JCIS_89_2020...
. É conveniente realizar ecocardiografia para investigar endocardite44 Kordzadeh A, Watson J, Panayiotopolous YP. Mycotic aneurysm of the superior and inferior mesenteric artery. J Vasc Surg. 2016;63(6):1638-46. http://dx.doi.org/10.1016/j.jvs.2016.01.031. PMid:26951998.
http://dx.doi.org/10.1016/j.jvs.2016.01....
. O exame tomografia por emissão de pósitrons com tomografia computadorizada (positron emission tomography/computed tomography scan, PET-CT SCAN) é uma ferramenta de alta acurácia diagnóstica, com grande sensibilidade, porém com especificidade prejudicada pelos resultados falso-positivos em casos de aneurismas inflamatórios e arterites2424 Husmann L, Huellner MW, Ledergerber B, et al. Diagnostic accuracy of PET/CT and contrast enhanced CT in patients with suspected infected aortic aneurysms. Eur J Vasc Endovasc Surg. 2020;59(6):972-81. http://dx.doi.org/10.1016/j.ejvs.2020.01.032. PMid:32340877.
http://dx.doi.org/10.1016/j.ejvs.2020.01...
.

Não há consenso sobre como definir a etiologia infecciosa primária do aneurisma55 Sörelius K, di Summa PG. On the diagnosis of mycotic aortic aneurysms. Clin Med Insights Cardiol. 2018;12:1179546818759678. http://dx.doi.org/10.1177/1179546818759678. PMid:29497343.
http://dx.doi.org/10.1177/11795468187596...
,1515 Dang Q, Van Eps RG, Wever JJ, et al. Nationwide study of the treatment of mycotic abdominal aortic aneurysms comparing open and endovascular repair in The Netherlands. J Vasc Surg. 2020;72(2):531-40. http://dx.doi.org/10.1016/j.jvs.2019.09.060. PMid:32061482.
http://dx.doi.org/10.1016/j.jvs.2019.09....
,1717 Wang TKM, Griffin B, Cremer P, et al. Diagnostic utility of CT and MRI for Mycotic Aneurysms: a meta-analysis. AJR Am J Roentgenol. 2020;215(5):1257-66. http://dx.doi.org/10.2214/AJR.19.22722. PMid:32930605.
http://dx.doi.org/10.2214/AJR.19.22722...
. Sugere-se que o diagnóstico seja estabelecido pela combinação de quadro clínico, exames laboratoriais e achados tomográficos11 Hurtado DFG, Neira JCH, Atala SH, Lawrence PT. Manejo de un aneurisma infeccioso. Rev Cir. 2019;71(5):446-9.,66 Guo Y, Bai Y, Yang C, Wang P, Gu L. Mycotic aneurysm due to Salmonella species: clinical experiences and review of the literature. Braz J Med Biol Res. 2018;51(9):e6864. http://dx.doi.org/10.1590/1414-431x20186864. PMid:29947649.
http://dx.doi.org/10.1590/1414-431x20186...
,1212 Zhu C, Zhao J, Huang B, Yuan D, Yang Y, Wang T. Long‐term outcome of endovascular aortic repair for mycotic abdominal aortic aneurysm. ANZ J Surg. 2020;90(7-8):1376-80. http://dx.doi.org/10.1111/ans.16122. PMid:32648327.
http://dx.doi.org/10.1111/ans.16122...
,1717 Wang TKM, Griffin B, Cremer P, et al. Diagnostic utility of CT and MRI for Mycotic Aneurysms: a meta-analysis. AJR Am J Roentgenol. 2020;215(5):1257-66. http://dx.doi.org/10.2214/AJR.19.22722. PMid:32930605.
http://dx.doi.org/10.2214/AJR.19.22722...
,2121 Patel AP, Cantos A, Butani D. Mycotic Aneurysm of the Hepatic Artery: a case report and its management. J Clin Imaging Sci. 2020;10:41. http://dx.doi.org/10.25259/JCIS_89_2020. PMid:32754376.
http://dx.doi.org/10.25259/JCIS_89_2020...
(Tabela 1). É fundamental esclarecer que o diagnóstico pode ser estabelecido na ausência de febre e hemoculturas positivas11 Hurtado DFG, Neira JCH, Atala SH, Lawrence PT. Manejo de un aneurisma infeccioso. Rev Cir. 2019;71(5):446-9.,33 Nagrodzki J, Sharrocks KE, Wong VK, Carmichael AJ. A mycotic aneurysm related to Salmonella Rissen infection: a case report. BMC Infect Dis. 2020;20(1):97. http://dx.doi.org/10.1186/s12879-020-4819-0. PMid:32005105.
http://dx.doi.org/10.1186/s12879-020-481...
,88 Deipolyi AR, Czaplicki CD, Oklu R. Inflammatory and infectious aortic diseases. Cardiovasc Diagn Ther. 2018;8(Suppl 1):S61-70. http://dx.doi.org/10.21037/cdt.2017.09.03. PMid:29850419.
http://dx.doi.org/10.21037/cdt.2017.09.0...
,99 Zeng Z, Li Z, Zhao Y, et al. Endovascular repair combined with staged drainage for the treatment of infectious aortic aneurysm: a case report. BMC Cardiovasc Disord. 2020;20(1):406. http://dx.doi.org/10.1186/s12872-020-01694-9. PMid:32894058.
http://dx.doi.org/10.1186/s12872-020-016...
,1515 Dang Q, Van Eps RG, Wever JJ, et al. Nationwide study of the treatment of mycotic abdominal aortic aneurysms comparing open and endovascular repair in The Netherlands. J Vasc Surg. 2020;72(2):531-40. http://dx.doi.org/10.1016/j.jvs.2019.09.060. PMid:32061482.
http://dx.doi.org/10.1016/j.jvs.2019.09....
,1616 Sörelius K, Wanhainen A, Furebring M, et al. Nationwide study of the treatment of mycotic abdominal aortic aneurysms comparing open and endovascular repair. Circulation. 2016;134(23):1822-32. http://dx.doi.org/10.1161/CIRCULATIONAHA.116.024021. PMid:27799273.
http://dx.doi.org/10.1161/CIRCULATIONAHA...
,2323 Kazuno K, Kinoshita H, Hori M, et al. Endovascular treatment for mycotic aneurysm using pyoktanin- applied devices. Cvir Endovascular. 2020;3(1):1-8. http://dx.doi.org/10.1186/s42155-020-00151-0. PMid:32886250.
http://dx.doi.org/10.1186/s42155-020-001...
. Após coleta de hemoculturas, iniciar antibioticoterapia para Staphylococcus sp, vancomicina, e antibioticoterapia para Salmonella sp: quinolonas ou cefalosporinas de terceira geração11 Hurtado DFG, Neira JCH, Atala SH, Lawrence PT. Manejo de un aneurisma infeccioso. Rev Cir. 2019;71(5):446-9.,44 Kordzadeh A, Watson J, Panayiotopolous YP. Mycotic aneurysm of the superior and inferior mesenteric artery. J Vasc Surg. 2016;63(6):1638-46. http://dx.doi.org/10.1016/j.jvs.2016.01.031. PMid:26951998.
http://dx.doi.org/10.1016/j.jvs.2016.01....
,1111 Wanhainen A, Verzini F, Van Herzeele I, et al. Editor’s Choice - European Society for Vascular Surgery (ESVS) 2019 Clinical Practice Guidelines on the Management of Abdominal Aorto-iliac Artery Aneurysms. Eur J Vasc Endovasc Surg. 2019;57(1):8-93. http://dx.doi.org/10.1016/j.ejvs.2018.09.020. PMid:30528142.
http://dx.doi.org/10.1016/j.ejvs.2018.09...
,1212 Zhu C, Zhao J, Huang B, Yuan D, Yang Y, Wang T. Long‐term outcome of endovascular aortic repair for mycotic abdominal aortic aneurysm. ANZ J Surg. 2020;90(7-8):1376-80. http://dx.doi.org/10.1111/ans.16122. PMid:32648327.
http://dx.doi.org/10.1111/ans.16122...
,1515 Dang Q, Van Eps RG, Wever JJ, et al. Nationwide study of the treatment of mycotic abdominal aortic aneurysms comparing open and endovascular repair in The Netherlands. J Vasc Surg. 2020;72(2):531-40. http://dx.doi.org/10.1016/j.jvs.2019.09.060. PMid:32061482.
http://dx.doi.org/10.1016/j.jvs.2019.09....
,1616 Sörelius K, Wanhainen A, Furebring M, et al. Nationwide study of the treatment of mycotic abdominal aortic aneurysms comparing open and endovascular repair. Circulation. 2016;134(23):1822-32. http://dx.doi.org/10.1161/CIRCULATIONAHA.116.024021. PMid:27799273.
http://dx.doi.org/10.1161/CIRCULATIONAHA...
,2323 Kazuno K, Kinoshita H, Hori M, et al. Endovascular treatment for mycotic aneurysm using pyoktanin- applied devices. Cvir Endovascular. 2020;3(1):1-8. http://dx.doi.org/10.1186/s42155-020-00151-0. PMid:32886250.
http://dx.doi.org/10.1186/s42155-020-001...
, a ser modificada ou associada a antifúngicos, de acordo com os resultados. Não há consenso quanto à duração do tratamento66 Guo Y, Bai Y, Yang C, Wang P, Gu L. Mycotic aneurysm due to Salmonella species: clinical experiences and review of the literature. Braz J Med Biol Res. 2018;51(9):e6864. http://dx.doi.org/10.1590/1414-431x20186864. PMid:29947649.
http://dx.doi.org/10.1590/1414-431x20186...

7 Kano Y, Takamatsu A, Honda H. Mycotic aneurysm due to Pasteurella multocida. QJM. 2020;113(9):667-9. PMid:32016425.
-88 Deipolyi AR, Czaplicki CD, Oklu R. Inflammatory and infectious aortic diseases. Cardiovasc Diagn Ther. 2018;8(Suppl 1):S61-70. http://dx.doi.org/10.21037/cdt.2017.09.03. PMid:29850419.
http://dx.doi.org/10.21037/cdt.2017.09.0...
,1111 Wanhainen A, Verzini F, Van Herzeele I, et al. Editor’s Choice - European Society for Vascular Surgery (ESVS) 2019 Clinical Practice Guidelines on the Management of Abdominal Aorto-iliac Artery Aneurysms. Eur J Vasc Endovasc Surg. 2019;57(1):8-93. http://dx.doi.org/10.1016/j.ejvs.2018.09.020. PMid:30528142.
http://dx.doi.org/10.1016/j.ejvs.2018.09...
,1919 Matsuo T, Mori N, Mizuno A, et al. Infected aortic aneurysm caused by Helicobacter cinaedi: case series and systematic review of the literature. BMC Infect Dis. 2020;20(1):854. http://dx.doi.org/10.1186/s12879-020-05582-7. PMid:33203370.
http://dx.doi.org/10.1186/s12879-020-055...
. A maioria dos autores sugere antibioticoterapia endovenosa pré-operatória por 1 a 6 semanas44 Kordzadeh A, Watson J, Panayiotopolous YP. Mycotic aneurysm of the superior and inferior mesenteric artery. J Vasc Surg. 2016;63(6):1638-46. http://dx.doi.org/10.1016/j.jvs.2016.01.031. PMid:26951998.
http://dx.doi.org/10.1016/j.jvs.2016.01....
,66 Guo Y, Bai Y, Yang C, Wang P, Gu L. Mycotic aneurysm due to Salmonella species: clinical experiences and review of the literature. Braz J Med Biol Res. 2018;51(9):e6864. http://dx.doi.org/10.1590/1414-431x20186864. PMid:29947649.
http://dx.doi.org/10.1590/1414-431x20186...
,1212 Zhu C, Zhao J, Huang B, Yuan D, Yang Y, Wang T. Long‐term outcome of endovascular aortic repair for mycotic abdominal aortic aneurysm. ANZ J Surg. 2020;90(7-8):1376-80. http://dx.doi.org/10.1111/ans.16122. PMid:32648327.
http://dx.doi.org/10.1111/ans.16122...
. O tratamento clínico isolado, com antibióticos, resulta em mortalidade acima de 80%1313 Berchiolli R, Mocellin DM, Marconi M, et al. Ruptured mycotic aneurysm after intravesical instillation for bladder tumor. Ann Vasc Surg. 2019;59:310.e7-310.e11. http://dx.doi.org/10.1016/j.avsg.2018.12.100. PMid:30802589.
http://dx.doi.org/10.1016/j.avsg.2018.12...
,1414 Wilson WR, Bower TC, Creager MA, et al. Vascular Graft Infections, Mycotic Aneurysms, and Endovascular Infections: a scientific statement from the American Heart Association. Circulation. 2016;134(20):e412-e460. http://dx.doi.org/10.1161/CIR.0000000000000457. PMid:27737955.
http://dx.doi.org/10.1161/CIR.0000000000...
,2323 Kazuno K, Kinoshita H, Hori M, et al. Endovascular treatment for mycotic aneurysm using pyoktanin- applied devices. Cvir Endovascular. 2020;3(1):1-8. http://dx.doi.org/10.1186/s42155-020-00151-0. PMid:32886250.
http://dx.doi.org/10.1186/s42155-020-001...
.

Tabela 1
Critérios sugestivos de etiologia infecciosa do aneurisma.

O tratamento cirúrgico deve envolver abordagem por procedimento endovascular ou cirurgia convencional11 Hurtado DFG, Neira JCH, Atala SH, Lawrence PT. Manejo de un aneurisma infeccioso. Rev Cir. 2019;71(5):446-9.,33 Nagrodzki J, Sharrocks KE, Wong VK, Carmichael AJ. A mycotic aneurysm related to Salmonella Rissen infection: a case report. BMC Infect Dis. 2020;20(1):97. http://dx.doi.org/10.1186/s12879-020-4819-0. PMid:32005105.
http://dx.doi.org/10.1186/s12879-020-481...
,66 Guo Y, Bai Y, Yang C, Wang P, Gu L. Mycotic aneurysm due to Salmonella species: clinical experiences and review of the literature. Braz J Med Biol Res. 2018;51(9):e6864. http://dx.doi.org/10.1590/1414-431x20186864. PMid:29947649.
http://dx.doi.org/10.1590/1414-431x20186...
,77 Kano Y, Takamatsu A, Honda H. Mycotic aneurysm due to Pasteurella multocida. QJM. 2020;113(9):667-9. PMid:32016425.,99 Zeng Z, Li Z, Zhao Y, et al. Endovascular repair combined with staged drainage for the treatment of infectious aortic aneurysm: a case report. BMC Cardiovasc Disord. 2020;20(1):406. http://dx.doi.org/10.1186/s12872-020-01694-9. PMid:32894058.
http://dx.doi.org/10.1186/s12872-020-016...
,1414 Wilson WR, Bower TC, Creager MA, et al. Vascular Graft Infections, Mycotic Aneurysms, and Endovascular Infections: a scientific statement from the American Heart Association. Circulation. 2016;134(20):e412-e460. http://dx.doi.org/10.1161/CIR.0000000000000457. PMid:27737955.
http://dx.doi.org/10.1161/CIR.0000000000...
,1515 Dang Q, Van Eps RG, Wever JJ, et al. Nationwide study of the treatment of mycotic abdominal aortic aneurysms comparing open and endovascular repair in The Netherlands. J Vasc Surg. 2020;72(2):531-40. http://dx.doi.org/10.1016/j.jvs.2019.09.060. PMid:32061482.
http://dx.doi.org/10.1016/j.jvs.2019.09....
,2121 Patel AP, Cantos A, Butani D. Mycotic Aneurysm of the Hepatic Artery: a case report and its management. J Clin Imaging Sci. 2020;10:41. http://dx.doi.org/10.25259/JCIS_89_2020. PMid:32754376.
http://dx.doi.org/10.25259/JCIS_89_2020...
,2323 Kazuno K, Kinoshita H, Hori M, et al. Endovascular treatment for mycotic aneurysm using pyoktanin- applied devices. Cvir Endovascular. 2020;3(1):1-8. http://dx.doi.org/10.1186/s42155-020-00151-0. PMid:32886250.
http://dx.doi.org/10.1186/s42155-020-001...
. A terapia endovascular para aneurisma infeccioso da aorta torácica foi descrita em 19982525 Semba CP, Sakai T, Slonim SM, et al. Mycotic aneurysms of the thoracic aorta: repair with use of endovascular stent-grafts. J Vasc Interv Radiol. 1998;9(1 Pt 1):33-40. http://dx.doi.org/10.1016/S1051-0443(98)70479-8. PMid:9468393.
http://dx.doi.org/10.1016/S1051-0443(98)...
. Desde então, seguiram-se vários relatos11 Hurtado DFG, Neira JCH, Atala SH, Lawrence PT. Manejo de un aneurisma infeccioso. Rev Cir. 2019;71(5):446-9.,33 Nagrodzki J, Sharrocks KE, Wong VK, Carmichael AJ. A mycotic aneurysm related to Salmonella Rissen infection: a case report. BMC Infect Dis. 2020;20(1):97. http://dx.doi.org/10.1186/s12879-020-4819-0. PMid:32005105.
http://dx.doi.org/10.1186/s12879-020-481...
,66 Guo Y, Bai Y, Yang C, Wang P, Gu L. Mycotic aneurysm due to Salmonella species: clinical experiences and review of the literature. Braz J Med Biol Res. 2018;51(9):e6864. http://dx.doi.org/10.1590/1414-431x20186864. PMid:29947649.
http://dx.doi.org/10.1590/1414-431x20186...
,88 Deipolyi AR, Czaplicki CD, Oklu R. Inflammatory and infectious aortic diseases. Cardiovasc Diagn Ther. 2018;8(Suppl 1):S61-70. http://dx.doi.org/10.21037/cdt.2017.09.03. PMid:29850419.
http://dx.doi.org/10.21037/cdt.2017.09.0...
,1212 Zhu C, Zhao J, Huang B, Yuan D, Yang Y, Wang T. Long‐term outcome of endovascular aortic repair for mycotic abdominal aortic aneurysm. ANZ J Surg. 2020;90(7-8):1376-80. http://dx.doi.org/10.1111/ans.16122. PMid:32648327.
http://dx.doi.org/10.1111/ans.16122...
,1515 Dang Q, Van Eps RG, Wever JJ, et al. Nationwide study of the treatment of mycotic abdominal aortic aneurysms comparing open and endovascular repair in The Netherlands. J Vasc Surg. 2020;72(2):531-40. http://dx.doi.org/10.1016/j.jvs.2019.09.060. PMid:32061482.
http://dx.doi.org/10.1016/j.jvs.2019.09....
,2121 Patel AP, Cantos A, Butani D. Mycotic Aneurysm of the Hepatic Artery: a case report and its management. J Clin Imaging Sci. 2020;10:41. http://dx.doi.org/10.25259/JCIS_89_2020. PMid:32754376.
http://dx.doi.org/10.25259/JCIS_89_2020...
,2323 Kazuno K, Kinoshita H, Hori M, et al. Endovascular treatment for mycotic aneurysm using pyoktanin- applied devices. Cvir Endovascular. 2020;3(1):1-8. http://dx.doi.org/10.1186/s42155-020-00151-0. PMid:32886250.
http://dx.doi.org/10.1186/s42155-020-001...
. Essa estratégia é menos invasiva, pois evitam-se dissecções em meio à anatomia comprometida pela infecção e não há pinçamento aórtico, o que em teoria beneficia pacientes com alto risco operatório11 Hurtado DFG, Neira JCH, Atala SH, Lawrence PT. Manejo de un aneurisma infeccioso. Rev Cir. 2019;71(5):446-9.,77 Kano Y, Takamatsu A, Honda H. Mycotic aneurysm due to Pasteurella multocida. QJM. 2020;113(9):667-9. PMid:32016425.,1111 Wanhainen A, Verzini F, Van Herzeele I, et al. Editor’s Choice - European Society for Vascular Surgery (ESVS) 2019 Clinical Practice Guidelines on the Management of Abdominal Aorto-iliac Artery Aneurysms. Eur J Vasc Endovasc Surg. 2019;57(1):8-93. http://dx.doi.org/10.1016/j.ejvs.2018.09.020. PMid:30528142.
http://dx.doi.org/10.1016/j.ejvs.2018.09...
. Todavia, o implante da endoprótese em tecido infectado aumenta a incidência de complicações, entre as quais infecção da endoprótese11 Hurtado DFG, Neira JCH, Atala SH, Lawrence PT. Manejo de un aneurisma infeccioso. Rev Cir. 2019;71(5):446-9.,66 Guo Y, Bai Y, Yang C, Wang P, Gu L. Mycotic aneurysm due to Salmonella species: clinical experiences and review of the literature. Braz J Med Biol Res. 2018;51(9):e6864. http://dx.doi.org/10.1590/1414-431x20186864. PMid:29947649.
http://dx.doi.org/10.1590/1414-431x20186...
,99 Zeng Z, Li Z, Zhao Y, et al. Endovascular repair combined with staged drainage for the treatment of infectious aortic aneurysm: a case report. BMC Cardiovasc Disord. 2020;20(1):406. http://dx.doi.org/10.1186/s12872-020-01694-9. PMid:32894058.
http://dx.doi.org/10.1186/s12872-020-016...
,2323 Kazuno K, Kinoshita H, Hori M, et al. Endovascular treatment for mycotic aneurysm using pyoktanin- applied devices. Cvir Endovascular. 2020;3(1):1-8. http://dx.doi.org/10.1186/s42155-020-00151-0. PMid:32886250.
http://dx.doi.org/10.1186/s42155-020-001...
, seu mau posicionamento e consequentes endoleaks com potencial ruptura do aneurisma44 Kordzadeh A, Watson J, Panayiotopolous YP. Mycotic aneurysm of the superior and inferior mesenteric artery. J Vasc Surg. 2016;63(6):1638-46. http://dx.doi.org/10.1016/j.jvs.2016.01.031. PMid:26951998.
http://dx.doi.org/10.1016/j.jvs.2016.01....
,88 Deipolyi AR, Czaplicki CD, Oklu R. Inflammatory and infectious aortic diseases. Cardiovasc Diagn Ther. 2018;8(Suppl 1):S61-70. http://dx.doi.org/10.21037/cdt.2017.09.03. PMid:29850419.
http://dx.doi.org/10.21037/cdt.2017.09.0...
. Outros desfechos indesejados incluem sepse, fístulas88 Deipolyi AR, Czaplicki CD, Oklu R. Inflammatory and infectious aortic diseases. Cardiovasc Diagn Ther. 2018;8(Suppl 1):S61-70. http://dx.doi.org/10.21037/cdt.2017.09.03. PMid:29850419.
http://dx.doi.org/10.21037/cdt.2017.09.0...
e crescimento do aneurisma1616 Sörelius K, Wanhainen A, Furebring M, et al. Nationwide study of the treatment of mycotic abdominal aortic aneurysms comparing open and endovascular repair. Circulation. 2016;134(23):1822-32. http://dx.doi.org/10.1161/CIRCULATIONAHA.116.024021. PMid:27799273.
http://dx.doi.org/10.1161/CIRCULATIONAHA...
. É fato que o tratamento endovascular não permite a remoção do tecido infectado99 Zeng Z, Li Z, Zhao Y, et al. Endovascular repair combined with staged drainage for the treatment of infectious aortic aneurysm: a case report. BMC Cardiovasc Disord. 2020;20(1):406. http://dx.doi.org/10.1186/s12872-020-01694-9. PMid:32894058.
http://dx.doi.org/10.1186/s12872-020-016...
,1212 Zhu C, Zhao J, Huang B, Yuan D, Yang Y, Wang T. Long‐term outcome of endovascular aortic repair for mycotic abdominal aortic aneurysm. ANZ J Surg. 2020;90(7-8):1376-80. http://dx.doi.org/10.1111/ans.16122. PMid:32648327.
http://dx.doi.org/10.1111/ans.16122...
,1616 Sörelius K, Wanhainen A, Furebring M, et al. Nationwide study of the treatment of mycotic abdominal aortic aneurysms comparing open and endovascular repair. Circulation. 2016;134(23):1822-32. http://dx.doi.org/10.1161/CIRCULATIONAHA.116.024021. PMid:27799273.
http://dx.doi.org/10.1161/CIRCULATIONAHA...
,2323 Kazuno K, Kinoshita H, Hori M, et al. Endovascular treatment for mycotic aneurysm using pyoktanin- applied devices. Cvir Endovascular. 2020;3(1):1-8. http://dx.doi.org/10.1186/s42155-020-00151-0. PMid:32886250.
http://dx.doi.org/10.1186/s42155-020-001...
e tem grande risco de apenas postergar a cirurgia por via aberta, assim adicionando o explante da endoprótese a um ato operatório já de alta complexidade.

A cirurgia convencional, com morbimortalidade de até 44%1212 Zhu C, Zhao J, Huang B, Yuan D, Yang Y, Wang T. Long‐term outcome of endovascular aortic repair for mycotic abdominal aortic aneurysm. ANZ J Surg. 2020;90(7-8):1376-80. http://dx.doi.org/10.1111/ans.16122. PMid:32648327.
http://dx.doi.org/10.1111/ans.16122...
, é o padrão-ouro1111 Wanhainen A, Verzini F, Van Herzeele I, et al. Editor’s Choice - European Society for Vascular Surgery (ESVS) 2019 Clinical Practice Guidelines on the Management of Abdominal Aorto-iliac Artery Aneurysms. Eur J Vasc Endovasc Surg. 2019;57(1):8-93. http://dx.doi.org/10.1016/j.ejvs.2018.09.020. PMid:30528142.
http://dx.doi.org/10.1016/j.ejvs.2018.09...
,1212 Zhu C, Zhao J, Huang B, Yuan D, Yang Y, Wang T. Long‐term outcome of endovascular aortic repair for mycotic abdominal aortic aneurysm. ANZ J Surg. 2020;90(7-8):1376-80. http://dx.doi.org/10.1111/ans.16122. PMid:32648327.
http://dx.doi.org/10.1111/ans.16122...
,1616 Sörelius K, Wanhainen A, Furebring M, et al. Nationwide study of the treatment of mycotic abdominal aortic aneurysms comparing open and endovascular repair. Circulation. 2016;134(23):1822-32. http://dx.doi.org/10.1161/CIRCULATIONAHA.116.024021. PMid:27799273.
http://dx.doi.org/10.1161/CIRCULATIONAHA...
,2222 Tshomba Y, Sica S, Minelli F, et al. Management of mycotic aorto-iliac aneurysms: a 30-year monocentric experience. Eur Rev Med Pharmacol Sci. 2020;24(6):3274-81. PMid:32271445., pois, embora proporcione recuperação mais lenta, apresenta menores taxas de reintervenção33 Nagrodzki J, Sharrocks KE, Wong VK, Carmichael AJ. A mycotic aneurysm related to Salmonella Rissen infection: a case report. BMC Infect Dis. 2020;20(1):97. http://dx.doi.org/10.1186/s12879-020-4819-0. PMid:32005105.
http://dx.doi.org/10.1186/s12879-020-481...
,66 Guo Y, Bai Y, Yang C, Wang P, Gu L. Mycotic aneurysm due to Salmonella species: clinical experiences and review of the literature. Braz J Med Biol Res. 2018;51(9):e6864. http://dx.doi.org/10.1590/1414-431x20186864. PMid:29947649.
http://dx.doi.org/10.1590/1414-431x20186...
. Além da ressecção aneurismática99 Zeng Z, Li Z, Zhao Y, et al. Endovascular repair combined with staged drainage for the treatment of infectious aortic aneurysm: a case report. BMC Cardiovasc Disord. 2020;20(1):406. http://dx.doi.org/10.1186/s12872-020-01694-9. PMid:32894058.
http://dx.doi.org/10.1186/s12872-020-016...
,1212 Zhu C, Zhao J, Huang B, Yuan D, Yang Y, Wang T. Long‐term outcome of endovascular aortic repair for mycotic abdominal aortic aneurysm. ANZ J Surg. 2020;90(7-8):1376-80. http://dx.doi.org/10.1111/ans.16122. PMid:32648327.
http://dx.doi.org/10.1111/ans.16122...
,1313 Berchiolli R, Mocellin DM, Marconi M, et al. Ruptured mycotic aneurysm after intravesical instillation for bladder tumor. Ann Vasc Surg. 2019;59:310.e7-310.e11. http://dx.doi.org/10.1016/j.avsg.2018.12.100. PMid:30802589.
http://dx.doi.org/10.1016/j.avsg.2018.12...
, a cirurgia deve incluir extenso desbridamento retroperitoneal, ressecção aórtica circunferencial99 Zeng Z, Li Z, Zhao Y, et al. Endovascular repair combined with staged drainage for the treatment of infectious aortic aneurysm: a case report. BMC Cardiovasc Disord. 2020;20(1):406. http://dx.doi.org/10.1186/s12872-020-01694-9. PMid:32894058.
http://dx.doi.org/10.1186/s12872-020-016...
,1313 Berchiolli R, Mocellin DM, Marconi M, et al. Ruptured mycotic aneurysm after intravesical instillation for bladder tumor. Ann Vasc Surg. 2019;59:310.e7-310.e11. http://dx.doi.org/10.1016/j.avsg.2018.12.100. PMid:30802589.
http://dx.doi.org/10.1016/j.avsg.2018.12...
,1616 Sörelius K, Wanhainen A, Furebring M, et al. Nationwide study of the treatment of mycotic abdominal aortic aneurysms comparing open and endovascular repair. Circulation. 2016;134(23):1822-32. http://dx.doi.org/10.1161/CIRCULATIONAHA.116.024021. PMid:27799273.
http://dx.doi.org/10.1161/CIRCULATIONAHA...
,2222 Tshomba Y, Sica S, Minelli F, et al. Management of mycotic aorto-iliac aneurysms: a 30-year monocentric experience. Eur Rev Med Pharmacol Sci. 2020;24(6):3274-81. PMid:32271445.,2323 Kazuno K, Kinoshita H, Hori M, et al. Endovascular treatment for mycotic aneurysm using pyoktanin- applied devices. Cvir Endovascular. 2020;3(1):1-8. http://dx.doi.org/10.1186/s42155-020-00151-0. PMid:32886250.
http://dx.doi.org/10.1186/s42155-020-001...
e revascularização in situ ou extra-anatômica com enxerto protético ou aloenxerto11 Hurtado DFG, Neira JCH, Atala SH, Lawrence PT. Manejo de un aneurisma infeccioso. Rev Cir. 2019;71(5):446-9.,99 Zeng Z, Li Z, Zhao Y, et al. Endovascular repair combined with staged drainage for the treatment of infectious aortic aneurysm: a case report. BMC Cardiovasc Disord. 2020;20(1):406. http://dx.doi.org/10.1186/s12872-020-01694-9. PMid:32894058.
http://dx.doi.org/10.1186/s12872-020-016...
,1111 Wanhainen A, Verzini F, Van Herzeele I, et al. Editor’s Choice - European Society for Vascular Surgery (ESVS) 2019 Clinical Practice Guidelines on the Management of Abdominal Aorto-iliac Artery Aneurysms. Eur J Vasc Endovasc Surg. 2019;57(1):8-93. http://dx.doi.org/10.1016/j.ejvs.2018.09.020. PMid:30528142.
http://dx.doi.org/10.1016/j.ejvs.2018.09...

12 Zhu C, Zhao J, Huang B, Yuan D, Yang Y, Wang T. Long‐term outcome of endovascular aortic repair for mycotic abdominal aortic aneurysm. ANZ J Surg. 2020;90(7-8):1376-80. http://dx.doi.org/10.1111/ans.16122. PMid:32648327.
http://dx.doi.org/10.1111/ans.16122...
-1313 Berchiolli R, Mocellin DM, Marconi M, et al. Ruptured mycotic aneurysm after intravesical instillation for bladder tumor. Ann Vasc Surg. 2019;59:310.e7-310.e11. http://dx.doi.org/10.1016/j.avsg.2018.12.100. PMid:30802589.
http://dx.doi.org/10.1016/j.avsg.2018.12...
,1616 Sörelius K, Wanhainen A, Furebring M, et al. Nationwide study of the treatment of mycotic abdominal aortic aneurysms comparing open and endovascular repair. Circulation. 2016;134(23):1822-32. http://dx.doi.org/10.1161/CIRCULATIONAHA.116.024021. PMid:27799273.
http://dx.doi.org/10.1161/CIRCULATIONAHA...
,2222 Tshomba Y, Sica S, Minelli F, et al. Management of mycotic aorto-iliac aneurysms: a 30-year monocentric experience. Eur Rev Med Pharmacol Sci. 2020;24(6):3274-81. PMid:32271445.. O by-pass extra-anatômico evita um enxerto em campo infectado; porém, pode ocorrer ruptura do coto aórtico, amputação do membro inferior ou reinfecção88 Deipolyi AR, Czaplicki CD, Oklu R. Inflammatory and infectious aortic diseases. Cardiovasc Diagn Ther. 2018;8(Suppl 1):S61-70. http://dx.doi.org/10.21037/cdt.2017.09.03. PMid:29850419.
http://dx.doi.org/10.21037/cdt.2017.09.0...
,1313 Berchiolli R, Mocellin DM, Marconi M, et al. Ruptured mycotic aneurysm after intravesical instillation for bladder tumor. Ann Vasc Surg. 2019;59:310.e7-310.e11. http://dx.doi.org/10.1016/j.avsg.2018.12.100. PMid:30802589.
http://dx.doi.org/10.1016/j.avsg.2018.12...
. Já na revascularização in situ, feita com enxerto impregnado em prata ou antibióticos1313 Berchiolli R, Mocellin DM, Marconi M, et al. Ruptured mycotic aneurysm after intravesical instillation for bladder tumor. Ann Vasc Surg. 2019;59:310.e7-310.e11. http://dx.doi.org/10.1016/j.avsg.2018.12.100. PMid:30802589.
http://dx.doi.org/10.1016/j.avsg.2018.12...
, a anastomose em leito infectado implica risco de deiscência e formação de pseudoaneurisma11 Hurtado DFG, Neira JCH, Atala SH, Lawrence PT. Manejo de un aneurisma infeccioso. Rev Cir. 2019;71(5):446-9.. Não há dados suficientes para comparar complicações entre enxertos in situ e extra-anatômicos, mas essas são mais comuns com o enxerto extra-anatômico1313 Berchiolli R, Mocellin DM, Marconi M, et al. Ruptured mycotic aneurysm after intravesical instillation for bladder tumor. Ann Vasc Surg. 2019;59:310.e7-310.e11. http://dx.doi.org/10.1016/j.avsg.2018.12.100. PMid:30802589.
http://dx.doi.org/10.1016/j.avsg.2018.12...
,2222 Tshomba Y, Sica S, Minelli F, et al. Management of mycotic aorto-iliac aneurysms: a 30-year monocentric experience. Eur Rev Med Pharmacol Sci. 2020;24(6):3274-81. PMid:32271445.. Estudos mostram mortalidade de 5-49% para enxertos in situ versus 24-50% para extra-anatômicos; complicações infecciosas ocorrem em aproximadamente 20% dos casos em ambas as estratégias1111 Wanhainen A, Verzini F, Van Herzeele I, et al. Editor’s Choice - European Society for Vascular Surgery (ESVS) 2019 Clinical Practice Guidelines on the Management of Abdominal Aorto-iliac Artery Aneurysms. Eur J Vasc Endovasc Surg. 2019;57(1):8-93. http://dx.doi.org/10.1016/j.ejvs.2018.09.020. PMid:30528142.
http://dx.doi.org/10.1016/j.ejvs.2018.09...
.

A dissecção em meio a tecidos espessados/aderidos aumenta o risco de sangramento e de lesões iatrogênicas, principalmente da veia cava e ureteres. O uso de cateteres duplo J previamente pode ajudar a identificar os ureteres em meio ao retroperitônio espessado2121 Patel AP, Cantos A, Butani D. Mycotic Aneurysm of the Hepatic Artery: a case report and its management. J Clin Imaging Sci. 2020;10:41. http://dx.doi.org/10.25259/JCIS_89_2020. PMid:32754376.
http://dx.doi.org/10.25259/JCIS_89_2020...
,2222 Tshomba Y, Sica S, Minelli F, et al. Management of mycotic aorto-iliac aneurysms: a 30-year monocentric experience. Eur Rev Med Pharmacol Sci. 2020;24(6):3274-81. PMid:32271445., como feito no caso 1. Se a dissecção do colo distal não for possível, o clampeamento pode ser substituído pela oclusão endovascular das ilíacas com sondas de Foley11 Hurtado DFG, Neira JCH, Atala SH, Lawrence PT. Manejo de un aneurisma infeccioso. Rev Cir. 2019;71(5):446-9.,2323 Kazuno K, Kinoshita H, Hori M, et al. Endovascular treatment for mycotic aneurysm using pyoktanin- applied devices. Cvir Endovascular. 2020;3(1):1-8. http://dx.doi.org/10.1186/s42155-020-00151-0. PMid:32886250.
http://dx.doi.org/10.1186/s42155-020-001...
, como nos casos 1 e 3. Para isolar a prótese dos tecidos adjacentes, pode-se envolvê-la em pedículo vascularizado do grande omento22 Dsouza R, Kota AA, Jain S, Agarwal S. Mycotic abdominal aortic aneurysm complicated by infective spondylitis due to Pseudomonas aeruginosa. BMJ Case Rep. 2020;13(2):1-3. http://dx.doi.org/10.1136/bcr-2019-233461.
http://dx.doi.org/10.1136/bcr-2019-23346...
,1111 Wanhainen A, Verzini F, Van Herzeele I, et al. Editor’s Choice - European Society for Vascular Surgery (ESVS) 2019 Clinical Practice Guidelines on the Management of Abdominal Aorto-iliac Artery Aneurysms. Eur J Vasc Endovasc Surg. 2019;57(1):8-93. http://dx.doi.org/10.1016/j.ejvs.2018.09.020. PMid:30528142.
http://dx.doi.org/10.1016/j.ejvs.2018.09...
,2222 Tshomba Y, Sica S, Minelli F, et al. Management of mycotic aorto-iliac aneurysms: a 30-year monocentric experience. Eur Rev Med Pharmacol Sci. 2020;24(6):3274-81. PMid:32271445.,2323 Kazuno K, Kinoshita H, Hori M, et al. Endovascular treatment for mycotic aneurysm using pyoktanin- applied devices. Cvir Endovascular. 2020;3(1):1-8. http://dx.doi.org/10.1186/s42155-020-00151-0. PMid:32886250.
http://dx.doi.org/10.1186/s42155-020-001...
como nos casos 1 e 3; a vascularização do omento também favorece a chegada do antibiótico à prótese22 Dsouza R, Kota AA, Jain S, Agarwal S. Mycotic abdominal aortic aneurysm complicated by infective spondylitis due to Pseudomonas aeruginosa. BMJ Case Rep. 2020;13(2):1-3. http://dx.doi.org/10.1136/bcr-2019-233461.
http://dx.doi.org/10.1136/bcr-2019-23346...
,1111 Wanhainen A, Verzini F, Van Herzeele I, et al. Editor’s Choice - European Society for Vascular Surgery (ESVS) 2019 Clinical Practice Guidelines on the Management of Abdominal Aorto-iliac Artery Aneurysms. Eur J Vasc Endovasc Surg. 2019;57(1):8-93. http://dx.doi.org/10.1016/j.ejvs.2018.09.020. PMid:30528142.
http://dx.doi.org/10.1016/j.ejvs.2018.09...
,2222 Tshomba Y, Sica S, Minelli F, et al. Management of mycotic aorto-iliac aneurysms: a 30-year monocentric experience. Eur Rev Med Pharmacol Sci. 2020;24(6):3274-81. PMid:32271445.. Também são descritos o uso de aorta criopreservada de cadáver, indisponível no Brasil, e a reconstrução usando enxerto feito a partir de ambas as veias femorais1111 Wanhainen A, Verzini F, Van Herzeele I, et al. Editor’s Choice - European Society for Vascular Surgery (ESVS) 2019 Clinical Practice Guidelines on the Management of Abdominal Aorto-iliac Artery Aneurysms. Eur J Vasc Endovasc Surg. 2019;57(1):8-93. http://dx.doi.org/10.1016/j.ejvs.2018.09.020. PMid:30528142.
http://dx.doi.org/10.1016/j.ejvs.2018.09...
,1313 Berchiolli R, Mocellin DM, Marconi M, et al. Ruptured mycotic aneurysm after intravesical instillation for bladder tumor. Ann Vasc Surg. 2019;59:310.e7-310.e11. http://dx.doi.org/10.1016/j.avsg.2018.12.100. PMid:30802589.
http://dx.doi.org/10.1016/j.avsg.2018.12...
,2222 Tshomba Y, Sica S, Minelli F, et al. Management of mycotic aorto-iliac aneurysms: a 30-year monocentric experience. Eur Rev Med Pharmacol Sci. 2020;24(6):3274-81. PMid:32271445.. Uso de cateteres duplo J para identificação dos ureteres, preparo de cólon com redução da necessidade de deslocar alças para fora da cavidade, acesso venoso central, monitorização invasiva da pressão arterial, uso de introdutor angiográfico 8F colocado na jugular interna para eventual infusão rápida de hemocomponentes, balanço hídrico positivo em pelo menos 1.000 mL antes da conclusão do ato operatório e aquecimento com manta térmica são alguns dos detalhes técnicos que melhoram os resultados cirúrgicos. Não há consenso a respeito da duração da antibioticoterapia pós-operatória88 Deipolyi AR, Czaplicki CD, Oklu R. Inflammatory and infectious aortic diseases. Cardiovasc Diagn Ther. 2018;8(Suppl 1):S61-70. http://dx.doi.org/10.21037/cdt.2017.09.03. PMid:29850419.
http://dx.doi.org/10.21037/cdt.2017.09.0...
. Alguns autores recomendam 6 semanas66 Guo Y, Bai Y, Yang C, Wang P, Gu L. Mycotic aneurysm due to Salmonella species: clinical experiences and review of the literature. Braz J Med Biol Res. 2018;51(9):e6864. http://dx.doi.org/10.1590/1414-431x20186864. PMid:29947649.
http://dx.doi.org/10.1590/1414-431x20186...
,1515 Dang Q, Van Eps RG, Wever JJ, et al. Nationwide study of the treatment of mycotic abdominal aortic aneurysms comparing open and endovascular repair in The Netherlands. J Vasc Surg. 2020;72(2):531-40. http://dx.doi.org/10.1016/j.jvs.2019.09.060. PMid:32061482.
http://dx.doi.org/10.1016/j.jvs.2019.09....
,1818 Watanabe N, Koyama S, Tabira M, et al. Infected aortic aneurysm caused by Streptococcus pyogenes: a case report. J Infect Chemother. 2021;27(4):647-9. http://dx.doi.org/10.1016/j.jiac.2020.11.008. PMid:33277175.
http://dx.doi.org/10.1016/j.jiac.2020.11...
,2222 Tshomba Y, Sica S, Minelli F, et al. Management of mycotic aorto-iliac aneurysms: a 30-year monocentric experience. Eur Rev Med Pharmacol Sci. 2020;24(6):3274-81. PMid:32271445., enquanto outros sugerem 3 a 6 meses44 Kordzadeh A, Watson J, Panayiotopolous YP. Mycotic aneurysm of the superior and inferior mesenteric artery. J Vasc Surg. 2016;63(6):1638-46. http://dx.doi.org/10.1016/j.jvs.2016.01.031. PMid:26951998.
http://dx.doi.org/10.1016/j.jvs.2016.01....
,66 Guo Y, Bai Y, Yang C, Wang P, Gu L. Mycotic aneurysm due to Salmonella species: clinical experiences and review of the literature. Braz J Med Biol Res. 2018;51(9):e6864. http://dx.doi.org/10.1590/1414-431x20186864. PMid:29947649.
http://dx.doi.org/10.1590/1414-431x20186...
,77 Kano Y, Takamatsu A, Honda H. Mycotic aneurysm due to Pasteurella multocida. QJM. 2020;113(9):667-9. PMid:32016425.,1111 Wanhainen A, Verzini F, Van Herzeele I, et al. Editor’s Choice - European Society for Vascular Surgery (ESVS) 2019 Clinical Practice Guidelines on the Management of Abdominal Aorto-iliac Artery Aneurysms. Eur J Vasc Endovasc Surg. 2019;57(1):8-93. http://dx.doi.org/10.1016/j.ejvs.2018.09.020. PMid:30528142.
http://dx.doi.org/10.1016/j.ejvs.2018.09...
,1212 Zhu C, Zhao J, Huang B, Yuan D, Yang Y, Wang T. Long‐term outcome of endovascular aortic repair for mycotic abdominal aortic aneurysm. ANZ J Surg. 2020;90(7-8):1376-80. http://dx.doi.org/10.1111/ans.16122. PMid:32648327.
http://dx.doi.org/10.1111/ans.16122...
,1515 Dang Q, Van Eps RG, Wever JJ, et al. Nationwide study of the treatment of mycotic abdominal aortic aneurysms comparing open and endovascular repair in The Netherlands. J Vasc Surg. 2020;72(2):531-40. http://dx.doi.org/10.1016/j.jvs.2019.09.060. PMid:32061482.
http://dx.doi.org/10.1016/j.jvs.2019.09....
, ou até antibioticoterapia vitalícia66 Guo Y, Bai Y, Yang C, Wang P, Gu L. Mycotic aneurysm due to Salmonella species: clinical experiences and review of the literature. Braz J Med Biol Res. 2018;51(9):e6864. http://dx.doi.org/10.1590/1414-431x20186864. PMid:29947649.
http://dx.doi.org/10.1590/1414-431x20186...
,1212 Zhu C, Zhao J, Huang B, Yuan D, Yang Y, Wang T. Long‐term outcome of endovascular aortic repair for mycotic abdominal aortic aneurysm. ANZ J Surg. 2020;90(7-8):1376-80. http://dx.doi.org/10.1111/ans.16122. PMid:32648327.
http://dx.doi.org/10.1111/ans.16122...
,2222 Tshomba Y, Sica S, Minelli F, et al. Management of mycotic aorto-iliac aneurysms: a 30-year monocentric experience. Eur Rev Med Pharmacol Sci. 2020;24(6):3274-81. PMid:32271445..

Doenças raras e de tratamento complexo requerem troca de informação; a discussão com colegas que sejam referência em cirurgia aórtica e a troca de experiências em grupos que praticam inteligência coletiva2626 Erzinger FL, de Araujo WJB, Ordinola AAM, et al. Vascular Forum: collective intelligence in the resolution of vascular clinical cases. J Vasc Bras. 2018;17(3):193-200. http://dx.doi.org/10.1590/1677-5449.005018. PMid:30643504.
http://dx.doi.org/10.1590/1677-5449.0050...
é importante para aumentar as chances de êxito. Portanto, a etiologia infecciosa deve ser sempre considerada diante de febre e dor abdominal/lombar com massa pulsátil, principalmente na vigência de infecção comprovada ou imunossupressão por doenças/medicamentos e se houver elevação de leucócitos e de marcadores inflamatórios. Hemoculturas frequentemente são negativas. Imagens angiotomográficas sugestivas incluem dilatações saculares, coleções perivasculares e rotura contida. Esperar por quadros “clássicos” e hemoculturas positivas para iniciar o tratamento correto pode comprometer o prognóstico do paciente.

Para o controle pós-operatório, recomenda-se a realização de angiotomografias no primeiro e no sexto mês, e posteriormente, de forma anual, para avaliação de complicações e necessidade de reintervenção1212 Zhu C, Zhao J, Huang B, Yuan D, Yang Y, Wang T. Long‐term outcome of endovascular aortic repair for mycotic abdominal aortic aneurysm. ANZ J Surg. 2020;90(7-8):1376-80. http://dx.doi.org/10.1111/ans.16122. PMid:32648327.
http://dx.doi.org/10.1111/ans.16122...
.

Entre as limitações desta série, encontra-se o pequeno número de casos e a ausência de documentação dos exames de imagem realizados no seguimento pós-operatório dos pacientes.

  • Como citar: Albuquerque FBA, Feijó MO, Smit JHA, Silva RB, Góes Junior AMO. Aneurisma infeccioso primário da aorta: série de casos e revisão da literatura. J Vasc Bras. 2022;21:e20210206. https://doi.org/10.1590/1677-5449.202102061
  • Fonte de financiamento: Nenhuma.
  • O estudo foi realizado no Centro Universitário do Estado do Pará (CESUPA), Belém, PA, Brasil.

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    Erzinger FL, de Araujo WJB, Ordinola AAM, et al. Vascular Forum: collective intelligence in the resolution of vascular clinical cases. J Vasc Bras. 2018;17(3):193-200. http://dx.doi.org/10.1590/1677-5449.005018 PMid:30643504.
    » http://dx.doi.org/10.1590/1677-5449.005018

Datas de Publicação

  • Publicação nesta coleção
    29 Jul 2022
  • Data do Fascículo
    2022

Histórico

  • Recebido
    08 Dez 2021
  • Aceito
    31 Maio 2022
Sociedade Brasileira de Angiologia e de Cirurgia Vascular (SBACV) Rua Estela, 515, bloco E, conj. 21, Vila Mariana, CEP04011-002 - São Paulo, SP, Tel.: (11) 5084.3482 / 5084.2853 - Porto Alegre - RS - Brazil
E-mail: secretaria@sbacv.org.br