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OBJECTIVES:
To present the case of a patient who underwent successful atypical management of a thoracoabdominal aortic graft infection and to suggest this alternative approach may be a viable treatment option in similar high risk patients.
METHODS:
The aortic graft infection was successfully managed by thoracic endovascular stent graft repair (TEVAR) and visceral debranching with omental wrap followed by long term antibiotic treatment.
RESULTS:
Our patient presented with an aortobronchial fistula and a thoracoabdominal graft infection caused by Proteus mirabilis. The patient underwent a temporary bridge procedure consisting of visceral debranching, infrarenal aortic reconstruction, and stent graft coverage of the pseudoaneurysm. After a period of recovery on long-term suppressive antibiotics, the infection resolved and the second stage procedure (graft excision and reconstruction using left atrial femoral bypass) was unnecessary. The patient remains asymptomatic and fully functional three years after the stage one procedure.
CONCLUSIONS:
The standard management for aortic graft infections is explantation of the graft, debridement of the infected area, in-situ reconstruction with an antibiotic-impregnated graft or extra-anatomic reconstruction, and vascularized omental or intercostal muscle wrap, followed by long term antibiotic suppression. However, this aggressive approach is not a viable treatment option in some high risk patients. The success of this case suggests that visceral debranching to enable a distal landing zone for TEVAR and chronic antibiotic suppression may be a new treatment option in similar high risk patients.