Management of Non-Infectious Aneurisms of the Sub-Kydney Abdominal Aorta at the CHU/JRA

Introduction: The aim of this study was to describe the principle of the management for non-infectious aneurysm of the sub-kidney abdominal aorta at the university teaching hospital/JRA Ampefiloha. Materials and methods: It was a retrospective, descriptive study conducted at cardiovascular surgery department of the university teaching hospital/JRA Ampefiloha, for a period of 14 years old (January 2005 to December 2019), including all patients who had an non-infectious aneurysm of the subrenal abdominal aorta at the CHU/JRA Ampefiloha operated on or not. Results: Sixty-one cases were included, with an mean age of 61.71 years old (from 16 to 82 years old), a male predominance (sex ratio-1.34), high blood pressure, dyslipidemia, active smoking and physical inactivity were the predominant risk factors. The circumstances of discovery were often abdominal pain (52.45%) and a flapping abdominal mass (47.54%). Aortic doppler ultrasound and/or CT angiography allowed the diagnosis and describe the type of aneurysm. Most of them was fusiform in 49 cases (80.32%) and sacciform in 12 cases (19.67%), the majority of which had a diameter of between 50 and 60 mm (36.06%). Thirty-nine patients were operated on (63.93%). Conventional surgery with the flattening of the aneurysm followed by a replacement with a prosthetic graft was our reference technique. Postoperative development was favorable in 82.05% of cases. The mortality rate was 6.56%. Conclusion: The hospital frequency of an abdominal aortic aneurysm was 1.53% at the university teaching hospital/JRA Ampefiloha. Conventional surgery was our reference technique, saving the lives of our patients. Keywords: Aneurysm, subrenal abdominal aorta, surgery, prosthesis.

Endovascular Treatment of Distal Posterior Cerebral Artery Infectious Aneurysm

Intracranial infectious aneurysms are rare entities accounting for approximately 1- 6 % of all cerebral aneurysms and have high propensity of rupture associated with mortality. The principal risk factor is infective endocarditis and the management includes antimicrobial treatment with or without obliteration of the aneurysm by microsurgical or endovascular means. We present a young patient with intracranial infectious aneurysm who was successfully treated with endovascular coil embolization. A 20-years-old female with history of rheumatic heart disease presented with subarachnoid hemorrhage due to rupture of IIA associated with infective endocarditis. Cerebral angiogram revealed right distal posterior cerebral artery aneurysm. Echocardiography showed vegetation in mitral valve and blood culture was positive for Enterococcus faecalis. Antibiotic treatment was administered for 6 weeks. The follow-up angiogram showed an enlarging aneurysm. So, the patient underwent endovascular coil embolization of the aneurysm preserving the parent artery. There were no post-procedure deficits. Intracranial infectious aneurysm should be considered as a differential diagnosis in a patient with infective endocarditis presenting with focal neurological deficits or altered consciousness. Early diagnosis and individualized approach are the key to successful treatment and endovascular treatment is an effective modality for such lesions.