Tuberculous Aneurysms and Vascular Complications
Summary
Tuberculous aneurysms represent a rare but life-threatening manifestation of extrapulmonary Mycobacterium tuberculosis infection. They arise when the bacilli invade the arterial wall either by direct extension from adjacent infected lymph nodes or vertebral bodies, or via haematogenous spread. The ensuing granulomatous inflammation leads to destruction of the media and adventitia, permitting blood to dissect through the weakened layers and form a true aneurysm or, more commonly, a pseudoaneurysm. These lesions most frequently involve the thoracic or abdominal aorta but may affect peripheral vessels. Clinical presentation ranges from insidious back or abdominal pain to acute rupture with catastrophic haemorrhage. Diagnosis is often delayed because early symptoms mimic other causes of pain and systemic signs may be subtle. Modern imaging techniques, including computed tomography angiography and magnetic resonance imaging, facilitate timely recognition by revealing saccular outpouchings, periaortic soft-tissue inflammation and associated lymphadenopathy or abscesses. Management requires a dual approach: prolonged antituberculous chemotherapy to eradicate infection and prompt vascular intervention to prevent rupture. Surgical options span open repair with graft replacement to minimally invasive endovascular stent grafting. Despite advances, morbidity and mortality remain high, particularly in resource-limited settings. A multidisciplinary strategy encompassing infectious disease specialists, radiologists and vascular surgeons is essential to optimise outcomes and reduce global disease burden.
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Tuberculous Aneurysms and Vascular Complications publication trend
The graph below shows the total number of articles in tuberculous aneurysms and vascular complications across all publications each year (not limited to Nature Index journals).
Technical terms
Pseudoaneurysm: A contained arterial wall rupture in which blood collects outside the true vessel lumen, bounded by adventitia or surrounding tissue rather than all three vessel layers.
Mycotic aneurysm: An aneurysm resulting from infection of the arterial wall, often due to bacterial or mycobacterial invasion causing arterial degeneration.
Endovascular aneurysm repair (EVAR): A minimally invasive procedure deploying a stent graft via the vasculature to exclude an aneurysm from circulation and reinforce the vessel wall.
Saccular aneurysm: A localized, sac-shaped bulge on one side of an artery, distinguished from fusiform aneurysms that involve the entire vessel circumference.
References
- Tuberculous Aortic Aneurysm - A Review. Brazilian Journal of Cardiovascular Surgery (2022).
- CT Imaging Manifestations of Tuberculous Aortic Aneurysm. Reviews in Cardiovascular Medicine (2022).
- Endovascular treatment of multiple tuberculous mycotic aneurysm. Medicine (2019).
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