Extra-Anatomical Aortic Bypass for Infected Aortic Arch Stent Graft: A Case Series

Area of Science:

• Cardiovascular Surgery
• Vascular Surgery
• Infectious Disease

Background:

• Stent graft infection is a severe complication of endovascular aortic repair, leading to high morbidity and mortality.
• Prompt treatment is crucial to prevent life-threatening issues like pseudoaneurysm, rupture, or fistula formation.
• Aorto-aortic extra-anatomical bypass is a specialized intervention for complex vascular issues, including infected aortic stent grafts.

Purpose of the Study:

• To describe the management of two young male patients with infected thoracic aortic stent grafts.
• To evaluate the feasibility and outcomes of aorto-aortic extra-anatomical bypass in treating aortic stent graft infections.

Main Methods:

• Case report of two young male patients with infected thoracic aortic stent grafts.
• Both patients underwent stent graft explantation and extra-anatomical ascending-to-descending aorto-aortic bypass.
• Procedures were performed under peripheral cardiopulmonary bypass with deep hypothermic circulatory arrest.

Main Results:

• Both patients survived the complex aortic surgery and remained clinically stable during follow-up (38 and 17 months).
• One patient required additional wound management for a surgical site infection.
• The other patient underwent delayed repair of an ascending aortic pseudoaneurysm.

Conclusions:

• Aorto-aortic extra-anatomical bypass is a feasible and potentially life-saving intervention for aortic endograft infection.
• Optimized perioperative management is key to successful outcomes in these complex cases.
• This approach offers a viable solution for selected patients with infected aortic stent grafts.