Endovascular repair of ascending aortic rupture: effectiveness of a fenestrated stent-graft.
OBJECTIVE
To present a technique for endovascular treatment using a fenestrated stent-graft in a patient with ascending aortic rupture in the setting of methicillin-resistant Staphylococcus aureus infection.


METHODS
A 62-year-old woman had undergone mastectomy and radiotherapy twice for breast cancer and then coronary artery bypass grafting (CABG). She developed sternal osteomyelitis 5 years after the CABG. Sternectomy and negative-pressure wound drainage were performed, but the infection did not resolve. Ascending aortic rupture occurred 5 months after sternectomy. Endovascular therapy was considered the only effective means of achieving hemostasis. A custom-designed fenestrated stent-graft was deployed from the ascending aorta to the proximal descending aorta via a femoral artery approach without transient cardiac arrest. Bleeding completely stopped after surgery. The postoperative course was uneventful, and the inflammatory activity subsided on antibiotic therapy. At 7 months after surgery, the patient's recovery has been uneventful.


CONCLUSIONS
Rupture of the ascending aorta associated with infection was successfully treated by stent-graft repair. The use of a custom-made, fenestrated stent-graft was an effective, lifesaving procedure for the management of this ascending aortic lesion.
Uchida
Keiji
K
Cardiovascular Center, Yokohama City University Medical Center, Yokohama, Japan. k_uchida@yokohama-cu.ac.jp
Imoto
Kiyotaka
K
Yanagi
Hiromasa
H
Machida
Daisuke
D
Okiyama
Makoto
M
Yasuda
Shota
S
Sugiura
Tadahisa
T
Kawaguchi
Satoshi
S
Yokoi
Yoshihiko
Y
Shigematsu
Hiroshi
H
Masuda
Munetaka
M
D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D001019:Aortic Rupture / Q000000981:diagnostic imaging / Q000601:surgery*; D001027:Aortography / Q000379:methods; D001807:Blood Vessel Prosthesis; D019917:Blood Vessel Prosthesis Implantation / Q000295:instrumentation*; D003646:Debridement; D005260:Female; D006801:Humans; D055624:Methicillin-Resistant Staphylococcus aureus / Q000302:isolation & purification*; D008875:Middle Aged; D010019:Osteomyelitis / Q000382:microbiology* / Q000628:therapy; D011474:Prosthesis Design; D013203:Staphylococcal Infections / Q000382:microbiology* / Q000628:therapy; D015607:Stents; D013530:Surgical Wound Infection / Q000382:microbiology* / Q000628:therapy; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
D000900:Anti-Bacterial Agents