Use of omental pedicles in mycotic abdominal aortic aneurysm repair

Area of Science:

• Vascular Surgery
• Infectious Diseases
• Aortic Aneurysm Management

Background:

• Mycotic abdominal aortic aneurysms (MAAAs) are rare but life-threatening conditions.
• MAAAs often present with complex infections, such as adjacent abscesses, complicating treatment.
• Prompt diagnosis and management are crucial for patient survival.

Purpose of the Study:

• To report a successful case of early aortic reconstruction for a mycotic infra-renal abdominal aortic aneurysm.
• To highlight the use of an in-situ prosthetic graft wrapped in an omental pedicle.
• To discuss the feasibility of this surgical approach despite persistent retroperitoneal sepsis.

Main Methods:

• A sixty-year-old male patient with a mycotic infra-renal abdominal aortic aneurysm and a left psoas abscess was treated.
• Initial management involved parenteral antibiotics.
• Early aortic reconstruction was performed using an in-situ prosthetic graft enveloped in an omental pedicle.

Main Results:

• The patient underwent successful early aortic reconstruction.
• The prosthetic graft was wrapped in an omental pedicle to potentially aid healing and prevent infection.
• The case demonstrates a viable treatment strategy for complex mycotic aneurysms.

Conclusions:

• Early aortic reconstruction with an in-situ prosthetic graft is a feasible treatment option for mycotic abdominal aortic aneurysms.
• Wrapping the graft in an omental pedicle may offer advantages in managing infection.
• This surgical technique can be considered even in the presence of ongoing retroperitoneal sepsis, though graft infection remains a risk.