Stapled bovine pericardial tube graft for infected thoracic aortic reconstruction: Geometric sizing and technical...

Aortic reconstruction in infected fields remains surgically challenging because of the risks of persistent infection, graft reinfection, and hemorrhagic complications. Biologic conduits, including bovine pericardial tube grafts, have emerged as attractive alternatives to synthetic grafts in these settings. However, limited data exist regarding stapled graft construction techniques and geometric sizing strategies. A 54-year-old man underwent thoracic endovascular aortic repair for a descending thoracic aortic penetrating ulcer complicated by periaortic hematoma. The postoperative course was complicated by persistent type Ib endoleak requiring thoracic endovascular aortic repair extension, followed by massive hemoptysis and concern for thoracic endograft infection. After staged stabilization and multidisciplinary evaluation, the patient underwent explantation of the infected thoracic endograft with hemiarch and descending thoracic aortic reconstruction using a custom stapled bovine pericardial tube graft. The graft was constructed intraoperatively using bovine pericardial patches and a vascular stapler. Graft sizing was determined using the circumference equation (C = π × D) to achieve accurate luminal diameter and avoid caliber mismatch. Additional overlap margins were incorporated to accommodate stapler application. Technical considerations regarding graft orientation, stapled seam construction, and staple-line exclusion from the final anastomosis are described. Stapled bovine pericardial tube graft reconstruction represents a feasible biologic option for thoracic aortic reconstruction in infected fields. Geometric sizing principles may improve graft calibration and reproducibility during physician-constructed conduit preparation.