section name header

Basics

Francisco Nacinovich

Martin E. Stryjewski

Matthew E. Falagas


BASICS


DESCRIPTION navigator

EPIDEMIOLOGY

Incidence navigator

Prevalence navigator

RISK FACTORS navigator

GENERAL PREVENTION navigator

Early recognition, diagnosis, and prompt initiation of antibiotic therapy in patients with IE.

PATHOPHYSIOLOGY navigator

ETIOLOGY navigator

COMMONLY ASSOCIATED CONDITIONS navigator


[Outline]

Diagnosis

DIAGNOSIS


HISTORY navigator

PHYSICAL EXAM navigator

DIAGNOSTIC TESTS & INTERPRETATION

Lab

Initial lab tests navigator

Follow Up & Special Considerations navigator

Culture of tissue (affected vessel) is positive in approximately 80% of cases

Imaging navigator

Several procedures are available; suspecting the localization of the MA is the key in selecting the initial procedure.

Initial Approach navigator

Follow Up & Special Considerations navigator

Compromise of multiple vessels could be found in up to 25% of patients.

Diagnostic Procedures/Other navigator

Pathological Findings navigator

Destruction of the normal arterial wall architecture with acute and chronic inflammation starting from vasa vasorum and progressively compromising the adventitial surface, the adjacent muscular layer, and then the internal elastic membrane allowing dilation and rupture. The intima can be intact. MAs usually occur at branching sites.

DIFFERENTIAL DIAGNOSIS navigator


[Outline]

Treatment

TREATMENT


MEDICATION navigator

ADDITIONAL TREATMENT

General Measures navigator

According to the clinical status

Issues for Referral navigator

Consult vascular surgery and or neurosurgery according to the affected vessels.

SURGERY/OTHER PROCEDURES navigator

IN PATIENT CONSIDERATIONS

Admission Criteria navigator

Clinical signs due to MA (e.g., compression, rupture, and leak) in a patient with risk factors (e.g., IE).

IV Fluids navigator

According to the clinical scenario

Nursing navigator

No specific recommendation.

Discharge Criteria navigator

When clinical status improves, patient is afebrile, and complications have resolved or have been adequately managed. Aneurysm should be stabilized or resolving.


[Outline]

Ongoing Care

ONGOING-CARE


FOLLOW-UP RECOMMENDATIONS navigator

Patient Monitoring navigator

DIET navigator

Rich in fiber to avoid constipation and excessive Valsalva (expert opinion)

PATIENT EDUCATION navigator

Patients should be aware of fever and symptoms that can be associated with their MA (e.g., headache, vision loss).

PROGNOSIS navigator

The mortality of MA is high and depends on the rupture. In patients with intracranial MA associated with IE, the overall mortality is around 50%; mortality in those who had a ruptured MA is 80%, and in those with intact MA is 30%, respectively.

COMPLICATIONS navigator


[Outline]

Additional Reading

Codes

CODES


ICD9

Clinical Pearls

References

  1. Baddour LM, Wilson WR, Bayer AS, et al. Infective endocarditis: Diagnosis, antimicrobial therapy, and management of complications. Circulation 2005;111:e394–e434.
  2. Wilson SE, Van Wagenen P, Passaro E Jr. Arterial infection. Curr Probl Surg 1978;15:1–89.
  3. Bisdas T, Teebken OE. Mycotic or infected aneurysm? Time to change the term. Eur J Vasc Endovasc Surg 2011;41:570.
  4. Anunnatsiri S, Chetchotisakd P, Kularbkaew C. Mycotic aneurysm in Northeast Thailand: The importance of Burkholderia pseudomallei as a causative pathogen. Clin Infect Dis 2008;47:1436–1439.
  5. Peters PJ, Harrison T, Lennox JL. A dangerous dilemma: Management of infectious intracranial aneurysms complicating endocarditis. Lancet Infect Dis 2006;6:742.
  6. Silverberg D, Halak M, Yakubovitch D, et al. Endovascular management of mycotic aortic aneurysms. Vasc Endovascular Surg 2010;44:693–696.
  7. Bisdas T, Bredt M, Pichlmaier M, et al. Eight-year experience with cryopreserved arterial homografts for the in situ reconstruction of abdominal aortic infections. J Vasc Surg 2010;52:323–330.