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DOI: 10.1055/s-0044-1787930
‘Case Report: Infected Descending Aorta TEVAR: A Severe Complication Requiring Complex Surgery’
Introduction: A 60 year-old male was admitted because of recurrent hemoptysis 2years after urgent TEVAR and ascending aorta replacement because of a large symptomatic aortic arch aneurysm.
Problem definition: This case describes the presentation and treatment of an infected TEVAR after hybrid thoracic aortic aneurysm repair.
Work summary: The patient presented in 2021 with hemoptysis. CT scan revealed a large ascending aortic aneurysm of 7cm and an even larger aneurysm of the descending aorta of 9cm, complicated by an aortobronchial fistula. The latter was treated urgently by TEVAR with carotid-subclavian artery bypass. After 2weeks replacement of the ascending aorta and aortic arch was performed through sternotomy, anchoring the arch prosthesis to the TEVAR. According to the suspected fistulisation antibiotic therapy was started.
In 2023, the patient presented with recurrent hemoptysis. Imaging revealed an infected thoracic endoprosthesis with partial dehiscence of the supra-aortic vessel anastomosis. Therefore a semi-urgent re-intervention was planned.
Results: Through sternotomy and superior laparotomy, an extra-anatomic bypass reconstruction (= ventral aorta) was created starting from the ascending aorta prosthesis to the supra-celiac aorta just above the coeliac trunk after splitting the diaphragm. From the ascending aorta both supra-aortic arteries (brachiocephalic trunk and left carotid artery) were revascularized by an extra-anatomical Y-graft. The TEVAR prostheses were extracted as of the distal thoracic aorta. The remaining descending thoracic aorta was rinsed and left in place after closing both ends by pericard patch proximally and direct suturing distally. After long revalidation and adequate antibiotic therapy, the patient left the hospital in good general condition.
Conclusion: Infection of a TEVAR is a challenging and life-threatening condition. Based on multidisciplinary approach, a strategy needs to be worked out to remove all infected prostheses, including complex extra-anatomical revascularization of all major arteries.
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Publikationsverlauf
Artikel online veröffentlicht:
11. Juni 2024
© 2024. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/)
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