Pattern of arterial aneurysms in acquired immunodeficiency disease
Marks, C.; Kuskov, S.
World Journal of Surgery 19(1): 127-132
1995
ISSN/ISBN: 0364-2313 PMID: 7740798 DOI: 10.1007/bf00316996Document Number: 290139
Surgeons conducted an analysis of 28 patients with cardiovascular aneurysms treated at Parirenyatwa Hospital in Zimbabwe during 1989-1993. The age of 16 of these patients ranged from 12 to 46 years. They did not show any customary cause of vascular aneurysms or occlusive disease. 12 of the 16 patients tested positive for HIV. Two were HIV negative at the time. The HIV status of two others was unknown. The sites of vascular involvement included abdominal aorta (3), iliac arteries (3), myocardium (2), thoracic aorta (2), popliteal artery (2), thoracoabdominal aorta (1), femoral artery (1), gluteal artery (1), and subclavian artery (1). The 16 patients were of young age (mean = 31 years), were indigenous Africans with no obvious atherosclerosis, trauma, or other known pathogenetic factors, and manifested rapid development of focal necrotizing arteriopathy with aneurysm formation and rupture and slow, progressive development of granulomatous vasculitis with vascular occlusion. The surgeons recommend excising all infected tissue in cases of mycotic aneurysms and performing extra-anatomic reconstruction to restore vascular continuity. In situ reconstruction is an acceptable alternative, should the surgeon be unable to create extra-anatomic conduits. Bypass procedures should be used to treat cases of occlusive vascular diseases, since the dense fibroproliferative changes thwart safe focal dissection. These findings suggest that HIV positive status has a causative relationship with vascular aneurysms or fibroproliferative aortoiliac occlusion and that this association is not coincidental in a region where HIV infection is common.
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