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Updated: Jun 25, 2026
Modified Octopus Technique for Thoracoabdominal Aortic Aneurysm
Published on: August 1, 2025
[Endovascular stent-grafting for mycotic thoracic aortic aneurysm]
1Department of Cardiovascular Surgery, Gunma Prefectural Cardiovascular Center, Maebashi, Japan.
Abstract:
We report 3 cases of endovascular stent-grafting (ESG) for mycotic thoracic aortic aneurysm. The case 1 was a rupture of pseudoaneurysm of the descending aorta caused by mediastinitis due to perforation of esophageal ulcer. The patient underwent emergent ESG for temporary control of the rupture. He underwent esophagus reconstruction 5 month after ESG. The case 2 was admitted due to inflammatory reaction. She was diagnosed with mycotic descending aortic aneurysm and underwent elective ESG because of her old age. Her postoperative course was uneventful and no infection recurred. The case 3 underwent ESG for a ruptured mycotic descending aortic aneurysm. But 113 days after ESG, he underwent ESG again for a ruptured endoleak of the stentgraft. His blood culture demonstrated methillin-resistant Staphylococcus aureus (MRSA). He died of rupture to bronchus and esophagus at 18th day after ESG. We believe that ESG is useful in high risk patients for temporary management of the rupture.
Insights
Endovascular stent-grafting (ESG) offers a viable option for managing ruptured mycotic thoracic aortic aneurysms, particularly in high-risk patients. While successful in some cases, complications like endoleaks and infection require careful consideration.
Area of Science:
- Cardiovascular Surgery
- Infectious Diseases
- Medical Devices
Background:
- Mycotic thoracic aortic aneurysms present a significant challenge due to infection risk and potential rupture.
- Endovascular stent-grafting (ESG) is an evolving treatment modality for complex aortic pathologies.
Observation:
- Three cases of mycotic thoracic aortic aneurysm treated with ESG are presented.
- Case 1: Ruptured pseudoaneurysm managed with emergent ESG, followed by esophageal reconstruction.
- Case 2: Elective ESG for a mycotic descending aortic aneurysm in an elderly patient with an uneventful recovery.
- Case 3: Ruptured mycotic aneurysm treated with ESG, complicated by a later endoleak and methicillin-resistant Staphylococcus aureus (MRSA) infection, leading to mortality.
Findings:
- ESG provided temporary rupture control in a high-risk patient.
- Successful elective ESG was achieved in one case with no recurrence.
- One case demonstrated the potential for late complications, including endoleak and MRSA infection, resulting in death.
Implications:
- ESG can be a crucial temporary measure for ruptured mycotic thoracic aortic aneurysms in high-risk individuals.
- Careful patient selection and long-term monitoring are essential for ESG success in these complex cases.
- Further research is needed to optimize ESG techniques and manage infectious complications in mycotic aortic aneurysms.
