Treatment of infected thoracic aortic aneurysm with combined abscess debridement and stent-graft wrapping using pedicled latissimus dorsi muscle flaps after thoracic endovascular aortic repair

Journal of Cardiothoracic Surgery

Case Report

Tohru Ishimine¹  Naoki Taniguchi¹  Hirokazu Matsushima¹  Toshiho Tengan¹ 

[1] Department of Cardiovascular Surgery, Okinawa Chubu Hospital, 281, Miyazato, 904-2293, Uruma-Shi, Okinawa, Japan;

关键词: Infected thoracic aortic aneurysm;    Thoracic endovascular repair;    Latissimus dorsi muscle flaps;    Stent-graft wrapping;   

DOI  :  10.1186/s13019-023-02155-y

 received in 2022-10-23, accepted in 2023-01-24,  发布年份 2023

来源: Springer

【 摘 要 】

BackgroundOpen thoracic surgery (with infected lesion removal, prosthetic graft replacement, and pedicled tissue flap) has remained the main treatment for infected thoracic aortic aneurysms to date. Recent reports have highlighted good prognostic outcomes with thoracic endovascular aortic repair. However, thoracic endovascular aortic repair for infected thoracic aortic aneurysms is associated with an exacerbation of infection due to residual infected tissues. We discuss the control of refractory infections following endovascular treatment of infected thoracic aortic aneurysms.Case presentationAn 81-year-old man, with a history of insulin-dependent diabetes mellitus and pancreaticoduodenectomy, presented to our emergency department with a fever. Blood tests revealed a markedly elevated leukocyte count, and contrast-enhanced computed tomography suggested a descending thoracic aortic pseudoaneurysm. We diagnosed the patient with an infected descending thoracic aortic aneurysm, and performed urgent thoracic endovascular aortic repair; he was started on an intravenous antibiotic treatment. Postoperatively, blood tests revealed a decreased leukocyte count and the patient remained afebrile. However, computed tomography revealed temporal enlargement of the abscess cavity; therefore, an abscess debridement and stent graft wrapping with pedicled latissimus dorsi muscle flaps were performed, which successfully controlled the infection. Six weeks after abscess debridement, the patient was switched to an oral antibiotic therapy. There was no evidence of recurrence of infection 8 months after the surgery.ConclusionsA combined abscess debridement and pedicled tissue flap approach is useful for patients with poor surgical tolerance in whom infection control is difficult after thoracic endovascular aortic repair for infected thoracic aortic aneurysms. Pedicled latissimus dorsi muscle flaps are useful when using the omentum for pedicled tissue flap is difficult.

【 授权许可】

CC BY   
© The Author(s) 2023

【 图 表 】

Fig. 4

Fig. 3

Fig. 6

Fig. 2

42004_2023_830_Article_IEq36.gif