Recurrence of multiple localizations of false tuberculous aneurysms after aortic surgery: A case report

Introduction and importance

Tuberculous aortic aneurysms require rigorous medical and surgical management due to the various complications that pose a significant life risk, with recurrence being one of the most formidable postoperative complications. This recurrence is linked to significant hemorrhage and infection, subsequently increasing the risk of mortality. Aneurysmal involvement due to tuberculosis is documented and can affect all arteries, but localization in the common iliac artery is rare and serious, necessitating immediate management.

Case presentation

We present the case of a 47-year-old man who had previously been treated for urogenital tuberculosis and underwent an aorto-aortic bypass three years ago for a juxtarenal abdominal aneurysm. The patient presented to the emergency room with abdominal pain. An emergency CT angiogram revealed a pseudoaneurysm at the site of the distal anastomosis of the bypass and a new pseudoaneurysm of the left common iliac artery. The patient underwent surgery, which involved the removal of the old aortic graft and a new aorto-bilateral iliac bypass using a Dacron graft. Histological analysis of the arterial samples collected during the operation confirmed the tuberculous origin of the aneurysm, and antituberculous treatment was extended for six months. After six months, the patient was in good general condition, and the bypass was patent.

Clinical discussion

For optimal results, medical treatment should precede surgical intervention. The choice between conventional and endovascular surgery is individualized for each case. However, endovascular treatment does not allow for debridement of the infected periaortic tissues, which is associated with a high risk of progression and recurrence of the infection, potentially leading to a fatal outcome.

Conclusion

Effective management requires antituberculous treatment and antibiotic therapy prior to surgical intervention to eliminate the aneurysm, control postoperative outcomes, and minimize complications related to tuberculosis.

The work has been reported in line with the SCARE criteria (Sohrabi et al., 2023 [17]).