Endovascular repair for a ruptured tuberculous thoracoabdominal aortic aneurysm and secondary lumbar spondylitis

Tuberculous spondylitis and psoas abscess secondary to mycotic thoracoabdominal aortic aneurysm are extremely rare. This life-threatening condition requires surgical treatment after diagnosis. Treatment of these patients involves specific antibacterial therapy combined with total resection of infected tissues and vascular reconstruction. At the same time, the most optimal surgical tactics in these patients is unclear. We present a 65-year-old male patient with tuberculous ostitis of L2-L4 vertebrae and right-sided psoas abscess secondary to 6-month-old ruptured mycotic thoracoabdominal aortic aneurysm. The main complaint at admission was severe lumbar pain. For diagnostic purposes, the patient underwent removal of right-sided retroperitoneal lesion with subsequent histological examination of tissues. Typical signs of tuberculosis infection required anti-tuberculosis chemotherapy. A month later, the patient underwent endovascular aortic repair due to infrarenal aortic enlargement and saccular protrusion of aortic wall within its bifurcation. Pain syndrome decreased after surgery. Postoperative CT revealed shrinkage of paraaortic hematoma and reduction of infrarenal aortic diameter. After 6 months, CT angiography confirmed pulsatile blood flow through the stented visceral arteries without endoleaks. Destruction zones of L2-L4 vertebrae decreased. This case demonstrates the possibility of endovascular treatment of a patient with ruptured mycotic thoracoabdominal aortic aneurysm with secondary tuberculous spondylitis and psoas abscess. This technique seems to be an acceptable alternative to open aortic repair in elderly comorbid patients.