Mycotic Aortic Aneurysm: Review of the Literature and Report of Two Cases

Document Type : Case Report


1 Vascular and Endovascular Surgery Research Center, Mashhad Medical University, Mashhad, Iran.

2 Department of General Surgery, Mashhad Medical University, Mashhad, Iran.


A mycotic aortic aneurysm (MAA), synonymously known as infected aortic aneurysm, is an aortic aneurysm due to infection. Mycotic aortic aneurysm most commonly develops through microbial inoculation of the diseased aortic endothelium during bacteremia. In this study we presented 2 Mycotic aortic aneurysm cases. In the first case the patient is a 50-year-old farmer who presented with a complaint of abdominal pain. The patient was consulted with the vascular surgery service for the diagnosis of ruptured abdominal aneurysm. The patient was prepared for surgery of a ruptured abdominal aortic aneurysm. After surgery, the patient's blood culture was reported negative after 72 hours, but the patient's aneurysm sac tissue culture reported Citrobacter freundii. The patient's antibiotic treatment regimen was changed according to the performed antibiogram. In another case A 65 year’s old male who was admitted in neurology ward was consulted with us, because of a pulsatile abdominal mass. The patient had Alzheimer disease and Brucellosis and didn’t receive a complete duration treatment for his Brucellosis. On surgery, we bypassed the defect and covered the graft with peritoneum. In first case the patient's blood culture was reported negative after 72 hours, but the patient's aneurysm sac tissue culture reported Citrobacter freundii. The patient's antibiotic treatment regimen was changed according to the performed antibiogram. In second case he was discharged without any surgical complication and on follow –up visit (7 months later) he didn’t have any complaint.


  1. Ahmed M, Ling L, Ettles D. Common and uncommon CT findings in rupture and impending rupture of abdominal aortic aneurysms. Clinical radiology. 2013;68(9):962-971.
  2. Heuts S, Sprooten RT, Heines SJ, Mees BM. Mechanical ventilation variability due to tracheal compression in a patient with a mycotic descending aortic aneurysm: an inverse correlation with blood pressure. European Journal of Cardio-Thoracic Surgery. 2020;58(4):864-866.
  3. Benrashid E, McCoy CC, Rice HE, Shortell CK, Cox MW. Mycotic saccular abdominal aortic aneurysm in an infant after cardiac catheterization: a case report. Annals of vascular surgery. 2015;29(7): e5- e11.
  4. Nathan DP, Xu C, Pouch AM, Chandran KB, Desjardins B, Gorman III JH, et al. Increased wall stress of saccular versus fusiform aneurysms of the descending thoracic aorta. Annals of vascular surgery. 2011;25(8):1129-1137
  5. Post IC, Vos CG. Systematic review and meta-analysis on the management of open abdominal aortic graft infections. European Journal of Vascular and Endovascular Surgery. 2019;58(2):258-281.
  6. Wilson WR, Bower TC, Creager MA, Amin-Hanjani S, O’Gara PT, Lockhart PB, et al. Vascular graft infections, mycotic aneurysms, and endovascular infections: a scientific statement from the American Heart Association. Circulation. 2016;134(20):e412-e460.
  7. Tshomba Y, Sica S, Minelli F, Giovannini S, Murri R, De Nigris F, et al. Management of mycotic aorto-iliac aneurysms: a 30-year monocentric experience. European review for medical and pharmacological sciences. 2020;24(6):3274-3281.
  8. Georgiadis GS, Bessias NC, Pavlidis PM, Pomoni M, Batakis N, Lazarides MK. Infected false aneurysms of the limbs secondary to chronic intravenous drug abuse: analysis of perioperative considerations and operative outcomes. Surgery today. 2007;37(10):837-844.
  9. Golledge J, Norman PE. Current status of medical management for abdominal aortic aneurysm. Atherosclerosis. 2011;217(1):57-63.
  10. Schwartz D, McCarville D, Wong A. Mycotic Abdominal Aortic Aneurysm Caused by Streptococcus equi. Cureus. 2021;13(3):13899-13901.
  11. Nair HR, Goura P, Pitchai S, Madathipat U. Brucella-induced ruptured infrarenal dissecting abdominal aortic aneurysm. AORTA. 2019;7(02):056-058.
  12. Liu M-Y, Jiao Y, Yang Y, Li Q, Zhang X, Li W, et al. Open surgery and endovascular repair for mycotic aortic aneurysms: benefits beyond survival. The Journal of thoracic and cardiovascular surgery. 2020;159(5):1708-1717.
  13. Kan C-D, Lee H-L, Yang Y-J. Outcome after endovascular stent graft treatment for mycotic aortic aneurysm: a systematic review. Journal of vascular surgery. 2007;46(5):906-912.
  14. Sörelius K, Mani K, Björck M, Sedivy P, Wahlgren C-M, Taylor P, et al. Endovascular treatment of mycotic aortic aneurysms: a European multicenter study. Circulation. 2014;130(24):2136-2142.
  15. Jia X, Dong Y-f, Liu X-p, Xiong J, Zhang H-p, Guo W. Open and endovascular repair of primary mycotic aortic aneurysms: a 10-year single-center experience. Journal of Endovascular Therapy. 2013;20(3):305-310.