Jornal Vascular Brasileiro
https://www.jvascbras.org/article/doi/10.1590/1677-5449.210160
Jornal Vascular Brasileiro
Case Report

Contained rupture of an aortic arch aneurysm in a patient with syphilitic aortitis. A case report

Ruptura contida de um aneurisma do arco aórtico em paciente com aortite sifilítica. Um relato de caso

Victor Bilman; Luca Bertoglio; Germano Melissano; Roberto Chiesa

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Abstract

Abstract: Syphilitic aortitis is a rare complication of tertiary syphilis, which can lead to aortic aneurysm formation, aortic valvular insufficiency, and ostial coronary stenosis. Syphilis has re-emerged worldwide over recent decades and vascular surgeons should be aware of its cardiovascular manifestations. Atypical clinical presentation, such as hemoptysis and a computed tomography angiography pattern of a thicker aneurysmal wall with ulcer-like aneurysm projections, should raise suspicion of syphilitic aortic aneurysm. An early diagnosis and appropriate surgical and medical therapies significantly contribute to successful treatment and favorable prognosis. Herein is reported the case of an 82-year-old male patient, positive for syphilis infection, with impending aortic arch aneurysm rupture treated with a hybrid arch repair. After 7 months, the patient was brought to the emergency room in cardiac arrest. Unsuccessful cardiopulmonary resuscitation maneuvers were performed, and an autopsy showed cardiac tamponade due to rupture of the ascending aorta.

Keywords

tertiary syphilis, aortic aneurysm, aortic rupture, endovascular technique

Resumo

Resumo: A aortite sifilítica é uma complicação rara da sífilis terciária, que pode levar a formação de aneurisma aórtico, insuficiência valvar aórtica e estenose ostial coronariana. Ao longo das últimas décadas, a sífilis ressurgiu ao redor do mundo, e os cirurgiões vasculares devem estar atentos às suas manifestações cardiovasculares. Apresentações clínicas atípicas, como a hemoptise, e um padrão na angiotomografia computadorizada de parede aneurismática mais grossa com projeções de aneurisma com aparência de úlcera devem levantar a suspeita de aneurisma sifilítico da aorta. O diagnóstico precoce e terapias cirúrgica e clínica adequadas contribuem significativamente para um tratamento bem-sucedido e prognóstico favorável. Relatamos o caso de um paciente do sexo masculino, de 82 anos, que apresentou infecção por sífilis com ruptura iminente de aneurisma do arco aórtico. Ele foi tratado com reparo híbrido do arco. Após 7 meses, o paciente deu entrada na emergência com parada cardiorrespiratória. As manobras de reanimação cardiopulmonar foram realizadas, mas não obtiveram sucesso, e a autópsia mostrou tamponamento cardíaco devido à ruptura da aorta ascendente.
 

Palavras-chave

sífilis terciária, aneurisma aórtico, ruptura aórtica, técnica endovascular

References

1 Girardi LN. Syphilitic aortitis: the bigger picture. J Thorac Cardiovasc Surg. 2017;154(2):e27-8. http://dx.doi.org/10.1016/j.jtcvs.2017.04.052. PMid:28528717.

2 Yuan SM. Syphilitic aortic aneurysm. Z Rheumatol. 2018;77(8):741-8. http://dx.doi.org/10.1007/s00393-018-0519-1. PMid:30073493.

3 Roberts WC, Barbin CM, Weissenborn MR, Ko JM, Henry AC. Syphilis as a cause of thoracic aortic aneurysm. Am J Cardiol. 2015;116(8):1298-303. http://dx.doi.org/10.1016/j.amjcard.2015.07.030. PMid:26307174.

4 Cocora M, Nechifor D, Lazar MA, Mornos A. Impending aortic rupture in a patient with syphilitic aortitis. Vasc Health Risk Manag. 2021;17:255-8. http://dx.doi.org/10.2147/VHRM.S289455. PMid:34079272.

5 İsbir S, Hamidov A, Seven İE, Ak K. Massive hemoptysis related to contained rupture of syphilitic aortic aneurysm into the pulmonary parenchyma. J Thorac Cardiovasc Surg. 2017;154(2):e23-5. http://dx.doi.org/10.1016/j.jtcvs.2017.03.134. PMid:28476425.

6 Stone JR, Bruneval P, Angelini A, et al. Consensus statement on surgical pathology of the aorta from the Society for Cardiovascular Pathology and the Association for European Cardiovascular Pathology: I. Inflammatory diseases. Cardiovasc Pathol. 2015;24(5):267-78. http://dx.doi.org/10.1016/j.carpath.2015.05.001. PMid:26051917.

7 Roberts WC, Kondapalli N. Operative recognition of syphilis of the aorta. Am J Cardiol. 2018;122(5):898-904. http://dx.doi.org/10.1016/j.amjcard.2018.05.030. PMid:30064859.

8 Roberts WC, Moore AJ, Roberts CS. Syphilitic aortitis: still a current common cause of aneurysm of the tubular portion of ascending aorta. Cardiovasc Pathol. 2020;46:107175. http://dx.doi.org/10.1016/j.carpath.2019.107175. PMid:31951962.

9 Roberts WC, Barbin CM, Weissenborn MR, Ko JM, Henry AC. Syphilis as a cause of thoracic aortic aneurysm. Am J Cardiol. 2015;116(8):1298-303. http://dx.doi.org/10.1016/j.amjcard.2015.07.030. PMid:26307174.

10 Del Re F, Falcetta GS, Pratali S, Belgio B, Pucci A, Bortolotti U. Syphilitic aortic aneurysm in the Third Millennium. Aorta. 2018;6(5):118-9. http://dx.doi.org/10.1055/s-0039-1683399. PMid:30934107.

11 Saraiva RS, César CA, Mello MA. Syphilitic aortitis: diagnosis and treatment. Case report. Rev Bras Cir Cardiovasc. 2010;25(3):415-8. http://dx.doi.org/10.1590/S0102-76382010000300021. PMid:21103753.

12 Pivatto F Jr, Finkler BS, Torres FS, Schaefer PG, Sprinz E. Aneurysm and dissection in a patient with syphilitic aortitis. Braz J Infect Dis. 2017;21(3):349-52. http://dx.doi.org/10.1016/j.bjid.2017.01.003. PMid:28238625.

13 Chaudhary F, Faghihimehr A, Subedi Y, Hodanazari SM, Yousaf MN. Syphilitic aortic aneurysm: a rare entity in the era of antibiotics. Cureus. 2021;13(3):e13647. http://dx.doi.org/10.7759/cureus.13647. PMid:33824800.

14 Tang YF, Han L, Xu ZY. Total arch replacement with stented elephant trunk technique for syphilitic thoracic aortic aneurysm. Chin Med J. 2020;134(2):225-7. http://dx.doi.org/10.1097/CM9.0000000000000993. PMid:32769499.

15 Heggtveit H. Syphilitic aortitis: a clinicopathologic autopsy study of 100 cases, 1950 to 1960. Circulation. 1964;29(3):346-55. http://dx.doi.org/10.1161/01.CIR.29.3.346. PMid:14128825.

16 Marconato R, Inzaghi A, Cantoni GM, Zappa M, Longo T. Syphilitic aneurysm of the abdominal aorta: report of two cases. Eur J Vasc Surg. 1988;2(3):199-203. http://dx.doi.org/10.1016/S0950-821X(88)80077-X. PMid:3410070.

17 Chitragari G, Laux AT, Hicks TD, Davies MG, Haidar GM. Rare Presentation of a Syphilitic Aneurysm of the Infrarenal Aorta with Contained Rupture. Ann Vasc Surg. 2018;47:279.e13-7. http://dx.doi.org/10.1016/j.avsg.2017.07.041. PMid:28887247.

18 Czerny M, Schmidli J, Adler S, et al. Editor’s Choice – Current Options and Recommendations for the Treatment of Thoracic Aortic Pathologies Involving the Aortic Arch: An Expert Consensus Document of the European Association for Cardio-Thoracic Surgery (EACTS) & the European Society for Vascu. Eur J Vasc Endovasc Surg. 2019;57(2):165-98. http://dx.doi.org/10.1016/j.ejvs.2018.09.016. PMid:30318395.

19 Gallitto E, Faggioli G, Spath P, et al. The risk of aneurysm rupture and target visceral vessel occlusion during the lead period of custom-made fenestrated/branched endograft. J Vasc Surg. 2020;72(1):16-24. http://dx.doi.org/10.1016/j.jvs.2019.08.273. PMid:32063442.
 

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