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Off-Pump Explantation of an Infected Thoracic Branched Endograft With Aortic Arch Exclusion
Nana Toyoda1, Benjamin Cho1, Taylor Laskowski2
1Division of Cardiothoracic and Vascular Surgery, Department of Surgery, University of Oklahoma Medical Center, Oklahoma City, Oklahoma, USA.
Background:
Endograft infection is a rare but devastating complication of thoracic endovascular aortic repair (TEVAR), traditionally managed with cardiopulmonary bypass and circulatory arrest.
Case Summary:
A 57-year-old man developed sepsis and hemoptysis 2 months after branched TEVAR for traumatic arch pseudoaneurysm. Imaging revealed perigraft infection with gas and extension into the lung. Given prohibitive risks of conventional bypass, an off-pump ascending-to-descending bypass with sequential supra-aortic debranching was performed via median sternotomy, enabling complete arch exclusion and explantation of the endograft. The patient recovered and remained well at 1-year follow-up.
Discussion:
This case demonstrates the feasibility of off-pump infected TEVAR explantation in critically ill patients, avoiding hypothermic circulatory arrest while achieving durable infection source control.
Take-Home Message:
Off-pump explantation of an infected branched TEVAR with complete arch exclusion may provide a life-saving alternative when conventional bypass strategies are considered prohibitive.
