Emergency treatment of rupture of the proximal anastomosis of an infected thoracoabdominal aortic graft with bleeding into a postpneumonectomy empyema cavity.
The thoracic part of a huge thoracoabdominal aortic aneurysm was resected. A prosthetic graft was implanted between the descending aorta and the iliac arteries. The celiac, superior mesenteric, and the renal arteries were connected to the aortic prosthesis with two bifurcation grafts. A life-threatening hemorrhage into an empyema cavity occurred postoperatively. An emergency two-stage procedure was employed involving: (1) exclusion of the infected intrathoracic segment and exclusion of an infected sutured aortic stump; (2) subsequent removal of necrotic and infected tissue, including the excluded segment of the aorta and the graft in a second operation. The patient recovered and is now well and works full-time. Angiography 3 years after the operation shows that all anastomoses are patent. A scheme of management of these rare cases is proposed.
Larsson
S
S
Department of Thoracic and Cardiovascular Surgery, Sahlgrenska Sjukhuset, Göteborg, Sweden.
Svensson
S
S
D000328:Adult; D000714:Anastomosis, Surgical; D001012:Aorta, Abdominal; D001013:Aorta, Thoracic; D001014:Aortic Aneurysm / Q000601:surgery*; D001807:Blood Vessel Prosthesis; D004630:Emergencies; D004653:Empyema / Q000150:complications*; D006488:Hemostasis, Surgical / Q000379:methods*; D006801:Humans; D008297:Male; D011183:Postoperative Complications / Q000601:surgery*