Covered Coronary Stent Graft in the Treatment of Hepatic Artery Pseudoaneurysm after Liver Transplantation

bacteremia, presumably from the colon. Mycotic suprarenal aortic aneurysms caused by B fragilis are very rare. We have found two case reports of patients treated surgically for B fragilis mycotic suprarenal aneurysms (4,5). Complicating this patient’s presentation is a history of lepromatous leprosy. Leprosy has well-documented effects on small arteries, veins, and nerves. We have not found literature describing the effects of leprosy on the aorta or its vasa vasorum. Although it is conceivable that lepromatous involvement of the aorta may have played a role in the development of this patient’s aneurysm, that role must remain speculative given endovascular treatment with no pathologic specimen obtainable. Aortic mycotic aneurysm is a fulminant infectious disease and may potentially progress to rupture and death unless appropriate treatment is instituted. The conventional strategy for the treatment of mycotic aneurysm is surgical intervention followed by long-term antibiotic therapy, which is essential to control systemic sepsis and to achieve cardiovascular stability (3). The surgical procedures are associated with substantial mortality rates associated with the risk of recurrent infection. Stanley et al (6) have reported endovascular stent treatment of four patients with mycotic aneurysms of the thoracic aorta. Semba et al (7) reported efficacy with endovascular treatment of a ruptured thoracic aortic aneurysm, which is known to be associated with high operative mortality and morbidity. The same group also successfully treated three patients with mycotic aortic aneurysm, including one patient with ruptured aneurysm, with stent-graft placement (8). There were no perioperative deaths or life-threatening complications during follow-up in their series. Successful outcomes in these small series, as well as the excellent outcome of our patient, suggest that endovascular stent-graft repair can play a role in definitive therapy for patients with mycotic thoracic aneurysms. The role of acute bacteremic infection in the development of mycotic aneurysms is well-known. The combined effect of underlying chronic lepromatous infection, an entity with documented vascular sequelae, is unknown and may warrant further study.