2025 Volume 54 Issue 3 Pages 122-126
We present the case of a 56-year-old man who had undergone a total debranched TEVAR for a distal arch aneurysm in an other hospital 7 years eariler. One year after the surgery, a graft infection occurred and the left subclavian artery graft was removed and an axillo-axillary bypass was done. However, the infection persisted and two cutaneous fistulae at the left neck and median sternotomy were recognized. Preoperative FDG-PET CT revealed a high uptake of FDG in the left common carotid artery graft, the stent graft in the ascending aorta, and the left neck wound and median sternotomy site. After we exposed the left common carotid artery, the left chest was entered through a posterolateral thoracotomy. The cardiopulmonary bypass was initiated by cannulating the left common femoral vessels and main pulmonary artery, and core cooling was done to 23℃. The descending aorta was clamped at the Th10 level, and the proximal descending aorta to arch was opened to remove the infected stent graft. Selective antegrade cerebral perfusion was started and antegrade cardioplegia was given. The ascending-arch-descending aorta was replaced with a rifampicin-soaked Dacron graft, followed by left common carotid artery reconstruction using an 8 mm Gore-Tex graft. The new graft was wrapped with a pedicled omental flap. Postoperative antibiotic therapy was continued for 6 weeks and the fistulae were surgically closed. The patient was discharged and is back to the normal life.
