Operative management for extent II thoracoabdominal aortoiliac reconstruction for pneumococcal aortitis

Area of Science:

• Cardiovascular Surgery
• Infectious Diseases
• Vascular Surgery

Background:

• Infectious aortitis is a rare but critical condition, often leading to mycotic aneurysms and potential vascular rupture.
• Prompt surgical intervention combined with antibiotics is essential when vascular disruption is evident.

Purpose of the Study:

• To present a case of Streptococcus pneumoniae aortitis requiring complex surgical management.
• To illustrate the successful surgical repair of thoracoabdominal aortic aneurysms in the context of infection.

Main Methods:

• A 68-year-old female patient with Streptococcus pneumoniae aortitis and multiple thoracoabdominal aortic aneurysms underwent urgent Crawford extent II thoracoabdominal aortoiliac reconstruction.
• The repair was performed under profound hypothermia (18°C) with Custodiol renal protection and cold blood visceral perfusion, utilizing a multibranched graft for individual visceral artery reimplantation.
• Severe aortic bifurcation calcification necessitated a bifurcated prosthesis for distal reconstruction.

Main Results:

• The patient underwent successful thoracoabdominal aortoiliac reconstruction despite challenges including extensive atheromatosis and spondylodiscitis.
• Histopathology confirmed aortic inflammation, and post-operative recovery was uneventful.
• At 1-year follow-up, the patient showed no signs of recurrence, with stable aortic repair and no need for suppressive antibiotics.

Conclusions:

• Complex infectious aortitis can be successfully managed with open surgical repair, even in the presence of comorbidities.
• This case demonstrates the efficacy of profound hypothermia and specialized grafting techniques in managing extensive thoracoabdominal aortic pathology.
• Long-term outcomes can be favorable, with stable repair achieved without the need for ongoing antibiotic therapy.