Unique Repair Of A Mycotic Extent IV TAAA Using Visceral Branching Technique
Recommended Citation
Pairawan SS, Shepard AD, Kabbani L, Peshkepija A. Unique Repair Of A Mycotic Extent IV TAAA Using Visceral Branching Technique. Ann Vasc Surg 2025; 112:442-443.
Document Type
Conference Proceeding
Publication Date
3-1-2025
Publication Title
Ann Vasc Surg
Keywords
antibiotic agent, rifampicin, aged, anastomosis, aortic clamping, assisted circulation, Bacteroides fragilis, case report, clinical article, conference abstract, dacron implant, debridement, drug therapy, hemodynamics, human, intravenous drug administration, ischemia time, leg ischemia, male, mean arterial pressure, mycosis, nonhuman, renal protection, special situation for pharmacovigilance, spinal cord ischemia, surgery, thoracic aorta
Abstract
Introduction and Objectives: A mycotic extent IV thoracoabdominal aneurysm (TAAA) is a lethal condition. This case study highlights a unique approach in the management of a mycotic extent IV TAAA. Methods: A 78-year-old male with a history of axillobifemoral bypass for lower extremity ischemia presented with a mycotic extent IV TAAA. He underwent resection/repair with a visceral branching (VB) technique utilizing a rifampin-soaked bifurcated Dacron graft modified with two additional sidearms through a thoracoabdominal approach. The graft was sewn end-to-side to the distal descending thoracic aorta. After stapling of the aorta just below the anastomosis, the aneurysm sac was opened and perfusion catheters (Figure 1) were inserted into the four visceral arteries. Aggressive debridement of the aneurysm sac was performed. Cultures demonstrated Bacteroides Fragilis. The postoperative course was complicated by temporary spinal cord ischemia managed aggressively, with elevated mean arterial pressure and a spinal drain and, with full recovery. Patient was discharged on 6 weeks of Intravenous and lifelong suppressive antibiotics. Figure 2 demonstrating post reconstruction CTA. Results: Contemporary repair of a mycotic extent IV TAAA involves aortic debridement and reconstruction while providing visceral and renal protection. Aortic cross-clamping produces significant hemodynamic effects, not well tolerated in many patients. VB decreases visceral ischemia time while circumventing the hemodynamic effects of aortic clamping. This is particularly advantageous in patients with limited physiological reserve. Conclusions: This report demonstrates the feasibility of modifying a standard bifurcated graft during an open mycotic extent IV TAAA repair without the need for circulatory support. [Formula presented] [Formula presented]
Volume
112
First Page
442
Last Page
443
