Open Repair of Aortic Arch Mycotic Pseudoaneurysms With Distal Perfusion

An 80-year-old man presented with a fast expanding 9.5-cm mycotic arch pseudoaneurysm. The right axillary and femoral arteries were cannulated. Through sternotomy, a reverse zone 2 arch replacement was performed with a 28-mm rifampin-soaked Hemashield aortic graft (Maquet, Wayne, NJ) graft with circulatory arrest. A 30-mm Coda balloon (Cook Medical, Bloomington, IN) was used to occlude the descending aorta, and the lower body was perfused through the femoral artery. The infected pseudoaneurysm was débrided and irrigated. A separate 28-mm rifampin-soaked Dacron graft was anastomosed to the proximal-descending aorta. The left subclavian artery was anastomosed to the proximal Dacron graft. Finally, the proximal and distal Dacron grafts were anastomosed together.