Year 2021 / Volume 113 / Number 1
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A mycotic hepatic artery aneurysm, a rare complication of aortic valve endocarditis

65-66

DOI: 10.17235/reed.2020.7093/2020

Jaime López-Sánchez, José Quiñones Sampedro, Luis Muñoz-Bellvís,

Abstract
A 58-year-old male underwent an aortic valve replacement due to an acute aortic regurgitation for aortic valve endocarditis. The patient maintained febrile syndrome during the postoperative period, in spite of broad-spectrum antibiotics. The CT scan showed an aneurysmal dilatation (45 mm in diameter) on the right hepatic artery. The appearance of a rapidly growing aneurysmal lesion, which was observed in previous radiologic examinations, suggested a diagnosis of a mycotic aneurysm secondary to infective endocarditis. A selected angiography of the celiac trunk was performed, which confirmed the diagnosis. An endovascular approach was applied and an aneurysm coil embolization was performed. Targeted antibiotic therapy was applied during 6 weeks and the patient showed an improvement and was discharged. He is currently asymptomatic. Discussion Mycotic hepatic artery aneurysms (MHAAs) are uncommon (less than 0.1%) and mainly affect the extrahepatic region (1). In most cases, MHAAs are asymptomatic and a high clinical suspicion is needed. Arteriography is the gold standard and it can be used as a diagnostic and therapeutic tool (2). MHAAs are associated with a high risk of rupture, even in patients without symptoms suggestive of MHAA or previous endocarditis (3). Thus, an early diagnosis and treatment is necessary. Surgery or endovascular techniques may be performed. The endovascular approach is accepted in intrahepatic MHAAs or in high risk patients (1,3). In our patient, a radiological exam was needed due to the persistent febrile syndrome. An endovascular approach was performed after a multidisciplinary team decision.
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References
1. Kim GA, Lee HC, Jin YJ et al. A case of ruptured mycotic hepatic artery aneurysm successfully treated using arterial embolization. Yeungnam University Journal of Medicine 2012; 29(1);24-27.
2. Abbas MA, Fowl RJ, Stone WM et al. Hepatic artery aneurysm: factors that predict complications. J Vasc Surg 2003;38:41-5.
3. Barquín-Yagüez J, Die-Trill J, García Pérez JC. Spontaneous liver rupture secondary to distal right hepatic artery microaneurysms in a patient admitted due to Staphylococcus
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López-Sánchez J, Quiñones Sampedro J, Muñoz-Bellvís L. A mycotic hepatic artery aneurysm, a rare complication of aortic valve endocarditis. 7093/2020


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Publication history

Received: 31/03/2020

Accepted: 13/04/2020

Online First: 20/11/2020

Published: 11/01/2021

Article revision time: 11 days

Article Online First time: 234 days

Article editing time: 286 days


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