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A 66-year-old man was found to have a mycotic aneurysm of the thoracic aorta. It was first suspected to be a pseudoaneurysm of the descending thoracic aorta on computed tomography scan, and the blood cultures were positive for methicillin-resistant Staphylococcus aureus (MRSA). It was subsequently diagnosed as a mycotic aneurysm, but because the patient continued to do so poorly with septicemia, conventional surgery (ie, aortic exclusion and extraanatomic bypass, or surgical placement of in situ graft) was not performed. A stent - graft device composed of several units of self-expandable Z stents covered with ultra-thin woven Dacron was inserted through 21F sheath via the left external iliac artery and aortography showed successful deployment without blood endoleaks. The procedure was completed without incident and the patient has continued to do well. Endovascular stent - grafts may offer significant advantages for patients at high surgical risk. (Circ J 2004; 68: 88 - 90)
