Infective native arterial aneurysms and inflammatory aortic aneurysms are rare but morbid pathologies seen by vascular surgeons in the emergency setting. Presentation is not always clear, and a full workup must be obtained before adopting a management strategy. Treatment is multidisciplinary and is tailored to every case based on workup findings. Imaging with computed tomography, magnetic resonance, or with fluorodeoxyglucose-positron emission tomography aids in diagnosis and in monitoring response to treatment. Open surgery is traditionally performed for definitive management. Endovascular surgery may offer an alternative treatment in select cases with acceptable outcomes. Neither technique has been proven to be superior to the other. Physicians should consider patient\'s anatomy, comorbidities, life expectancy, and goals of care before selecting an approach. Long-term pharmacological treatment, with antibiotics in case of infective aneurysms and immunosuppressants in case of inflammatory aneurysms, is usually required and should be managed in collaboration with infectious disease specialists and rheumatologists.

UNASSIGNED: Mycotic carotid pseudoaneurysms represent a challenge for surgeons. They are rare and associated with high mortality and morbidity.
UNASSIGNED: We reported a case of a 61-year-old man with a mycotic pseudoaneurysm of carotid bifurcation. The case was managed by a staged procedure, starting with initial endovascular control using a stent graft, followed by open arterial reconstruction using a saphenous vein graft.
UNASSIGNED: The patient was discharged home with a patent carotid artery and no sign of infection or bleeding. A computed tomography scan performed at 1 month, 6 months, and 1 year later confirmed good patency of the graft without imaging of cerebral ischemia.
UNASSIGNED: Mycotic pseudoaneurysms of the extracranial carotid artery are rare and should always be treated surgically. This disease, despite its rarity, requires early detection and treatment to avoid fatal outcomes. A hybrid staged approach is suggested, compared to one-staged surgery, to avoid rupture and improve clinical outcomes. This approach involves using a stent graft combined with antibiotic therapy as bridge treatment until definitive surgery can be performed to enable arterial reconstruction with an autologous graft.

Infected or mycotic aortic aneurysms (MAAs) are a rare type of aneurysms. Due to the high risk of rupture, MAAs are life-threatening conditions. Early diagnosis and treatment are necessary, yet MAAs are usually found coincidentally. We report 10 patients with MAAs in whom macroscopically, similar coined-sized lesions of the inner aortic wall were seen in all cases. When a coin-sized lesion in the inner aortic wall is seen during open surgical repair of an aortic aneurysm, the surgeon should consider an infectious cause. Microbiological tissue samples should be collected, and additional targeted antibiotic therapy should be started.

Airway obstruction requires urgent intervention. When dealing with the right brachiocephalic artery mycotic pseudoaneurysms, the risk of rupture and massive hemorrhage adds greater urgency to the management. Furthermore, tracheal compression presents difficulties during airway management. This report highlights the airway and anesthetic challenges encountered during the procedure and emphasizes the importance of tailored intervention for optimal patient care. We describe the clinical case of a 38-year-old male patient who presented with a large recurrent right brachiocephalic artery pseudoaneurysm associated with tracheal compression. The patient required urgent surgical intervention due to the pseudoaneurysm\'s enlargement and progressive respiratory distress. Awake fiber-optic intubation was not feasible. A cardiopulmonary bypass was kept on standby in the event of failed intubation and ventilation, or circulatory collapse. Endotracheal intubation was performed successfully using a video-laryngoscopy. After successful surgical repair of the pseudoaneurysm, the patient was transferred to ICU where he was extubated 48 hours post-surgery, following treatment with methylprednisolone for edematous aryepiglottic folds identified during video-laryngoscopy. Overall, this case emphasizes the importance of early diagnosis, prompt surgical intervention, and effective teamwork in managing rare and potentially life-threatening conditions like mycotic pseudoaneurysms. It also highlights the critical role of anesthesiologists in providing optimal perioperative care, ensuring hemodynamic stability, managing airway challenges, and facilitating successful surgical outcomes. In our work, we also provide a summary of the reported similar cases.

Surgical repair of a subclavian artery mycotic aneurysm is dependent on aneurysm-specific characteristics and anatomic exposures could require sternotomy, thoracotomy, or supraclavicular incisions. Alternatively, a median claviculectomy can be used. We successfully performed a subclavian artery to axillary artery bypass with median claviculectomy in a 23-year-old man with multiple comorbidities. Postoperative Doppler ultrasound showed a patent left axillary artery with a palpable left radial artery, and the patient demonstrated full left shoulder range of motion without any significant deformities. This case suggests that a median claviculectomy can produce satisfactory outcomes in patients with subclavian artery mycotic aneurysms.

Mycotic pseudoaneurysm of the ascending aorta is extremely uncommon, particularly in children with no prior cardiac surgery or trauma. We report a rare case of a mycotic pseudoaneurysm of the ascending aorta in a 2-year-old girl with no history of cardiac surgery. Investigations revealed a methicillin-resistant Staphylococcus aureus infection and significant pericardial effusion in the child who presented with persistent fever and altered mental state. Cardiac ultrasound revealed a disruption in the aortic wall and a tumor-like structure. Contrast-enhanced computed tomography confirmed an ascending aortic pseudoaneurysm with thrombus. The child underwent successful surgical treatment without implants. This case emphasizes the diagnostic significance of imaging, particularly the advantages of ultrasound in pediatric settings, and the need for timely and accurate diagnosis using appropriate imaging modalities in children.

In recent years, mycotic aortic aneurysms have been increasingly treated successfully by endovascular means. The introduction of custom-made fenestrated and branched devices, parallel graft techniques, and in situ fenestration has enabled total endovascular treatment also for arch pathologies. We describe a total endovascular repair of a mycotic arch aneurysm with in situ laser fenestration using venoarterial extracorporeal membrane oxygenation to preserve flow to vital organs.

UNASSIGNED: Fungal infections should always be considered in difficult-to-treat paranasal sinus conditions. Sphenoid fungal balls are characterized by the presence of dense fungal masses in the sinus cavity without invasion of surrounding tissues. This case emphasizes the importance of accurate terminology and management and also highlights the involvement of rare pathogens such as Drechslera hawaiiensis. Diagnosis is typically based on imaging studies and intraoperative findings. Accurate identification of the pathogen is crucial. Fungal infections of the paranasal sinuses, including fungus balls, can present challenges in diagnosis and treatment. D. hawaiiensis, although infrequent, can cause potential life-threatening infections.
UNASSIGNED: We present a 26-year-old non-HIV male patient who presented with nasal symptoms and mild headaches. The patient underwent an endoscopic exploration that revealed a soft, grayish lesion with a buttery consistency. Gross total resection was achieved and the lesion was identified as being caused by D. hawaiiensis; thus, intravenous antifungal treatment was given.
UNASSIGNED: Endoscopic surgery remains the preferred approach for disease control. Considering alternative treatments and exploring novel approaches are essential in managing complex pathologies in neurosurgical practice.

UNASSIGNED: Ruptured mycotic pararenal aortic aneurysms are rare and serious condition that requires prompt treatment. Open surgery with aortic resection and in-situ or extra-anatomic reconstruction is the standard treatment. The aim of this technical note is to report urgent endovascular treatment using a readily available custom-made device (created for another patient), with a back-table modification using pericardium patch and a new fenestration.
UNASSIGNED: In preoperative measurements on centerline-based workstation, aortic diameter in proximal and distal landing zone and target vessel position matched the measurements of graft plan of custom-made device (CMD) besides left renal artery. To address current patient`s anatomy, closure of the nonsuitable fenestration with pericardial patch and creation of new fenestration (1 cm above and 1:15 hours posterior to original fenestration) for the respective target vessel have been performed. Postoperative computed tomography angiography (CTA) scan showed complete exclusion of aneurysm, perfused target vessels, and no endoleak. Under resistance-based antibiotic therapy, the patient was asymptomatic and showed normal infection parameters in blood samples postoperatively.
UNASSIGNED: In the hands of an experienced endovascular aortic surgeon modification of a custom-made device is a quick and feasible technique in this emergency situation. Long-term follow-up must confirm the durability and reliability of this new technique.
UNASSIGNED: The described technique of modification of a custom-made endograft can provide an alternative endovascular treatment option for urgent complex abdominal aortic pathologies. Compared to the current available treatment modalities, like physician modified endografts, off-the-shelf branched devices, parallel grafts and in-situ fenestration, it can save considerable time and provides reasonable sealing in ruptured cases. The technique offers a valuable add-on to the armamentarium of experienced endovascular physicians.

We present a case of a 77-year-old patient who presented with a stroke. She subsequently became unwell and was found to have a spontaneous infective native carotid artery pseudoaneurysm. The patient was managed conservatively as per her wishes. Despite the rarity of this clinical diagnosis, clinicians should be aware of the pathophysiology of this entity and the available literature on management.