Een mycotisch thoracaal aorta-aneurysma veroorzaakt door Listeria monocytogenes

Abstract

Mycotic thoracic aortic aneurysm caused by Listeria monocytogenes An 85-year-old male patient with hoarseness and constitutional symptoms was diagnosed with Listeria monocytogenes aortitis. Given his comorbidities and age, open surgery was not indicated. A thoracic endovascular aortic repair (TEVAR) was chosen and oral antibiotics were given for 6 months after the intervention, with the goal of lifelong suppressive therapy to prevent a flare-up. The patient died 59 months later of an unrelated cause. Listeria monocytogenes is a rare cause of thoracic aortic aneurysm. Open surgical treatment is considered the golden standard for mycotic aortic aneurysms (MAAs). If open surgical repair is not feasible (because of comorbidities), an endovascular approach can be considered. Since no large trials and high-quality data on long-term outcomes are available, the use of endovascular techniques is limited to patients with a lot of comorbidities (where it is considered a palliative intervention) or as a bridge to definitive open surgery. Survival on both short and middle-long term is better with an endovascular aneurysm repair (EVAR) compared to open surgery. However, more infectious complications are seen with EVAR, which have a high mortality rate. When treated with an endovascular technique, the best results are seen in patients presenting without rupture, who are afebrile at the time of surgery and who are on antibiotics 3-7 days prior to and minimal 6 months after the intervention. There is no consensus on the ideal duration of the antibiotic treatment, but a minimum of 6 months improves the survival significantly. Nevertheless, it remains important to adjust the therapy to each individual patient.