Endovascular repair of Thoracoabdominal aneurysm aorta and generalized mycobacterial infection (Clinical case)

Mikhail Chernyavskiy¹Almaz Vanyurkin¹Ekaterina Verkhovskaya¹Yuliya Panteleeva¹Daria Ryzhkova¹Ilona Basek¹Anton Ryzhkov¹Lubov Mitrofanova¹Dmitry Gulyaev¹Galina Salogub¹Ivan Danilov¹Anna Starshinova^1,2,3*Dmitry Ovchinnikov¹Dmitry Kudlay⁴Evgeny Shlyakhto¹

• ¹Almazov National Medical Centre, St.-Petersburg, Russia
• ²Saint Petersburg State University, Saint Petersburg, Russia
• ³Almazov, St.-Petersburg, Russia
• ⁴Lomonosov Moscow State University, Moscow, Russia

Abstract Mycotic aortic aneurysms accounted for only 0.7–1.3% of all aortic aneurysms but remained a life-threatening vascular complication with in-hospital mortality rates reaching 36%. Immediate surgical intervention was required due to the high risk of rupture. Standard management combined targeted antimicrobial therapy with radical resection of infected tissues and vascular reconstruction, yet the choice of optimal surgical strategy in elderly, comorbid patients remained controversial. Endovascular interventions are pivotal in the treatment of patients at high risk of infections, offering a minimally invasive approach that reduces the likelihood of complications and improves treatment outcomes We reported the case of a 65-year-old male who presented with severe lumbar pain. He was diagnosed with mycobacterial spondylitis of the L2–L4 vertebrae and a right-sided psoas abscess secondary to a ruptured thoracoabdominal mycotic aneurysm of six months' duration. For diagnostic purposes, a right retroperitoneal mass was excised, and histological examination demonstrated features consistent with mycobacterial infection. Based on these findings, anti-tuberculosis chemotherapy was initiated. Considering the patient's advanced age and comorbidities, branched endovascular aortic repair (BEVAR) was performed as a less invasive alternative to open surgery. This rare clinical case demonstrated the feasibility of BEVAR as a therapeutic option for ruptured thoracoabdominal aortic aneurysm complicated by disseminated mycobacterial infection and psoas abscess. The successful outcome suggested that BEVAR could serve as an effective alternative to open repair in selected high-risk patients.