Abstract
We present the technical details of en bloc resection and extended replacement of an infected aortic arch. A 74-year-old man underwent emergent surgery under a diagnosis of impending rupture of an infected aortic arch aneurysm. The patient’s chest was entered through a median sternotomy with a left thoracotomy at the fourth intercostal space. After dissection of the left phrenic and left recurrent nerves, the infected aortic arch was widely excised en bloc under circulatory arrest with selective cerebral perfusion. It was replaced with a rifampicin-bonded prosthetic graft. The prosthesis and anastomoses were covered with a harvested omental flap. Although an appropriate approach and supportive therapy are indispensable, en bloc resection of the infected tissue is an important technique when treating infected aortic aneurysms.
Similar content being viewed by others
References
Shrager JB, Wain JC, Wright CD, Donahue DM, Vlahakes GJ, Moncure AC, et al. Omentum is highly effective in the management of complex cardiothoracic surgical problems. J Thorac Cardiovasc Surg 2003;125:526–532.
Bandyk DF, Novotney ML, Johnson BL, Back MR, Roth SR. Use of rifampin-soaked gelatin-sealed polyester grafts for in situ treatment of primary aortic and vascular prosthetic infections. J Surg Res 2001;95:44–49.
Totsugawa T, Kuinose M, Yoshitaka H, Ishii S, Tsushima Y, Ishida A. Intraoperative endotoxin adsorption as a new therapeutic option for mycotic aortic aneurysm. Circ J 2008;72:161–163.
Totsugawa T, Ozawa M, Kuinose M, Ishii S, Yoshitaka H, Tamaki T. Intraoperative endotoxin adsorption for visceral malperfusion complicating acute type A aortic dissection. Gen Thorac Cardiovasc Surg 2010;58:134–137.
Sapirstein W. A method of reinforcing vascular prosthetic anastomosis. Surgery 1971;70:744–745.
Reddy DJ, Weaver MR. Infected aneurysm. In: Rutherford RB, editor. Vascular surgery. 6th edn. Philadelphia: Elsevier Saunders; 2005. p. 1581–1596.
Totsugawa T, Kuinose M, Yoshitaka H, Tsushima Y, Ishida A, Minami H. Mycotic aortic aneurysm induced by Klebsiella pneumoniae successfully treated by in situ replacement with rifampicin-bonded prosthesis: report of three cases. Circ J 2007;71:1317–1320.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Totsugawa, T., Takiuchi, H., Kuinose, M. et al. En bloc resection and extended replacement of the infected aortic arch. Gen Thorac Cardiovasc Surg 59, 418–421 (2011). https://doi.org/10.1007/s11748-010-0697-5
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s11748-010-0697-5