Extra-Anatomic Management of Homograft Reinfection after Thoracic Aortic Rupture

Abstract

Vascular graft infections involving the thoracic aorta have high morbidity and mortality rates. The management of homograft reinfection has not been discussed yet. A 23-year-old woman suffered a rupture of the descending thoracic aorta. Seven months after interposition of a Dacron graft she was readmitted for graft infection and a homograft was inserted. An esophageal lesion was oversewn. Follow-up CT showed several aneurysms around the homograft. She underwent implantation of an extra-anatomic ascending-descending aorta Dacron bypass with stump closure of the descending aorta. The patient is alive and free from reinfection seven years later.

Aortic disease - cardiovascular surgery - thoracic surgery

References

• 1 Coselli J S, Crawford E S, Williams T W. et al . Treatment of postoperative infection of ascending aorta, and transverse arch, including use of viable omentum and muscle flaps.  Ann Thorac Surg. 1990;  50 868-881
• 2 Svensson L G, Crawford E S, Hess K R, Coselli J S, Safi H J. Experience with 1509 patients undergoing thoracoabdominal aortic operations.  J Vasc Surg. 1993;  17 357-370
• 3 Vogt P R, Turina M I. Management of infected aortic grafts: development of less invasive surgery using cryopreserved homografts.  Ann Thorac Surg. 1999;  67 1986-1989
• 4 Soyer R, Bessou J P, Bouchart F, Redonnet M, Mouton-Schleifer D, Arrignon J. Surgical treatment of infected composite graft after replacement of ascending aorta.  Ann Thorac Surg. 1994;  58 425-428
• 5 Arbatli H, DeGeest R, Demirsoy E. et al . Management of infected grafts and mycotic aneurysms of the aorta using cryopreserved homografts.  Cardiovascular Surgery. 2003;  11 257-263
• 6 Coselli J S, Köksoy C, LeMaire S A. Management of thoracic aortic graft infections.  Ann Thorac Surg. 1999;  67 1990-1993