Management of a thoracic endograft infection through an ascending to descending extra-anatomic aortic bypass and endograft explantation.
A 52-year-old man presented 33 months after thoracic aortic endovascular repair with hemoptysis and was found to have an aortobronchial fistula secondary to a mycotic aneurysm. The endograft infection was managed in a two-stage fashion. During the initial stage, the patient underwent an ascending-to-descending thoracic aortic bypass. Neither cardiopulmonary bypass, hypothermic circulatory arrest, nor aortic cross-clamping were used. During the same hospitalization, the patient underwent successful endograft explantation through a left thoracotomy. Imaging at 6 months demonstrated no anastomotic concerns and resolution of residual pulmonary inflammation. Thoracic aortic endograft infections necessitating endograft removal can potentially be successfully and safely managed without the need for cardiopulmonary bypass, hypothermic circulatory arrest, or interruption of aortic blood flow.
Riesenman
Paul J
PJ
Department of Surgery, Division of Vascular Surgery, University of North Carolina, Chapel Hill, NC 27599-7212, USA.
Farber
Mark A
MA
D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D017545:Aortic Aneurysm, Thoracic / Q000601:surgery*; D001018:Aortic Diseases / Q000000981:diagnostic imaging / Q000382:microbiology / Q000601:surgery*; D001027:Aortography / Q000379:methods; D001807:Blood Vessel Prosthesis / Q000009:adverse effects*; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects* / Q000295:instrumentation; D001983:Bronchial Fistula / Q000000981:diagnostic imaging / Q000382:microbiology / Q000601:surgery*; D020878:Device Removal; D006469:Hemoptysis / Q000382:microbiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D016459:Prosthesis-Related Infections / Q000000981:diagnostic imaging / Q000382:microbiology / Q000601:surgery*; D011550:Pseudomonas aeruginosa / Q000302:isolation & purification; D012086:Reoperation; D056346:Sternotomy; D013908:Thoracotomy; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D016157:Vascular Fistula / Q000000981:diagnostic imaging / Q000382:microbiology / Q000601:surgery*
D000900:Anti-Bacterial Agents