Two-Stage Procedure for Infected Aortic Graft Pseudoaneurysm: 10-Year Follow Up after Omental Prosthesis Wrapping

Abstract

Prosthetic graft infections with mediastinitis following aortic surgery are rare, yet represent grave complications yielding high morbidity and mortality. We present the case of a 57-year-old female patient with past history of emergent surgery for iatrogenic Type A dissection treated by supracoronary ascending aortic replacement. Four months after the initial surgery, a sternal fistula had formed and due to severe bleeding emergent reoperation was required. Imaging and pathology on admission revealed an infected pseudoaneurysm at the distal aortic prosthesis and mediastinitis with met hicillin-resistant Staphylococcus aureus. Rescue surgery was performed by means of a two-stage approach, with extensive debridement, graft replacement and continuous antiseptic lavage in a first step and an omental wrapping of the new prosthesis in a second stage 24 hours later. During 10 years of follow-up, no recurrent infection occurred. The operative approach and general considerations for management of infected pseudoaneurysms are discussed.

Omental Flap for Complex Sternal Wounds and Mediastinal Infection Following Cardiac Surgery

“…17,18 A combination of these is a two-step approach with aortic prosthesis replacement, extensive debridement, and antiseptic lavage in the first stage, followed by an OF wrapping of the new graft in a second step 24 to 72 hours later. [19][20][21][22] In a multicenter retrospective study on 58 patients with infected intrathoracic vascular prosthesis, Oda et al found that the use of an OF to wrap the infected grafts was associated with a reduction in the mortality. 23 Over the years, we also adopted mainly the two-step approach, with more than satisfactory results.…”