Neo-Aortoiliac reconstruction of complicated aneurysms: First case report in a Peruvian hospital

Mycotic aneurysms are rare vascular pathologies requiring tailored surgical approaches in septic and anatomically complex settings. We present the case of a 68-year-old male with diabetes mellitus and tobacco use, admitted with abdominal sepsis and purulent perianal discharge. Imaging revealed a ruptured 90 mm infrarenal abdominal aortic aneurysm with features suggestive of an aortomesenteric fistula. Due to the high risk of prosthetic graft infection, aortic reconstruction with an autologous femoral vein was selected. After preoperative venous mapping, a bifurcated graft was constructed using a reversed femoral vein following the Neo-aortoiliac system principles and the Myller cuff technique. During laparotomy, the contained ruptured aneurysm with multiple adhesions was confirmed, and the autologous graft was interposed proximally at the aorta and distally at the iliac arteries. This case highlights the feasibility of autologous vein grafting in complex infected aortic reconstruction within a septic setting.