Reply to Steichen. Survival from ruptured aortic aneurysm without any operations

The introduction of the case report ‘Conservative treatment for rupture of thoracic aortic aneurysm’ by Namai and Sakurai is somewhat misleading [1]. Four references are cited to support the statement that tuberculous involvement of blood vessels is rare, which is true but off-topic. Indeed, the reported aneurysm was not caused by tuberculosis; it merely involved a patient with a history of lung tuberculosis. The authors even suggest that this healed tuberculosis was beneficial, because residual fibrous scars around the aorta might have contained the bleeding from the ruptured aneurysm. It should be emphasised that the treatment of tuberculous aortic aneurysms, unlike the reported case, combines antitubercular drugs and aortic repair [2]. Surgical repair and debridement of surrounding infected tissues is the best option. However, successful endovascular repair has been reported in a case of tuberculous aneurysm of the aortic isthmus without adjacent infected tissue [3]. Endovascular repair is also a palliative alternative when surgery is impossible or refused by the patient [4]. 4/92/500476 by gest on 09 Feruary 2019 References