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Management of Mycotic Thoracic Aortic Aneurysm With Staged Hybrid Approach

Hossam Alslaim1, Jane Chung1, Mrinal Shukla1

  • 1Medical College of Georgia at Augusta University, Department of Surgery, Division of Vascular and Endovascular Surgery, Augusta, Georgia.

Annals of Vascular Surgery
|April 8, 2021
PubMed

Insights

This case study details a staged hybrid repair for a mycotic thoracic aortic aneurysm in a young male. The successful treatment involved endovascular repair and surgical debridement, leading to a good outcome.

Area of Science:

  • Cardiovascular Surgery
  • Infectious Diseases
  • Aortic Aneurysm Research

Background:

  • Mycotic thoracic aortic aneurysms are rare but life-threatening infections.
  • Staged hybrid repair offers a potential treatment strategy for complex aortic pathologies.
  • Early diagnosis and intervention are crucial for managing mycotic aneurysms.

Observation:

  • A 30-year-old male with polysubstance abuse presented with chest pain and leukocytosis.
  • Computed Tomography Angiography (CTA) revealed a rapidly expanding mycotic thoracic aortic pseudoaneurysm.
  • Infection was confirmed to be Methicillin-resistant Staphylococcus aureus (MRSA).

Findings:

  • The patient underwent emergent thoracic endovascular aortic repair (TEVAR).
  • This was followed by surgical debridement of the posterior mediastinum within 24 hours.
  • Long-term antibiotic therapy was initiated post-operatively.

Implications:

  • Staged hybrid repair can be an effective treatment for mycotic thoracic aortic aneurysms.
  • This approach achieved complete pseudoaneurysm exclusion with no endoleak at one-year follow-up.
  • Successful management highlights the importance of multidisciplinary care in complex aortic infections.

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