Abstract
We report 3 cases of infected thoracoabdominal aortic aneurysm without any occurrence of hospital death. Case 1 was a 74-year-old man. Staphylococcus aureus (methicillin-sensitive) was positive in a blood culture preoperatively. We used a rifampicin-soaked branched prosthesis to replace the thoracoabdominal aorta. The prosthesis was covered with the omentum. About 3 years after surgery, the patient died of pneumonia, but no complications in his aorta were observed postoperatively. Case 2 was a 75-year-old woman. Three months after lower gastrointestinal endoscopy, thoracoabdominal aortic aneurysm developed. A branched prosthesis was used to replace the aorta. Streptococcus pneumoniae was isolated from the aneurysm wall. Rifampicin was not used because it had not been prepared, and neither was the omentum used because it was atrophic after colon surgery. However, the patient is alive without vascular problems at 5 years after surgery. Case 3 was a 75-year-old man. A rapidly expanding thoracoabdominal aortic aneurysm was observed during investigation of a previous small aneurysm. Blood culture showed Staphylococcus capitis. A rifampicin-soaked branched prosthesis was used and covered with the omentum. He has been healthy for 2.5 years after surgery. In summary, our strategies, including in-situ reconstruction using a rifampicin-soaked branched prosthesis, omental covering, and intravenous antibiotic administration for at least 1 month after surgery, may provide good mid-term results. In addition to the multimodal control of infection, a multidisciplinary approach toward minimally-invasive treatment against thoracoabdominal aortic aneurysm may be warranted.
