Aortic pseudoaneurysm due to graft infection after invasive thymoma resection

Abstract

A 69-year-old woman with invasive thymoma underwent chemoradiotherapy followed by surgical resection, including extended thymectomy, right upper lobectomy, and innominate vein and superior vena cava reconstruction with a polytetrafluoroethylene graft. Computed tomography on the 27th postoperative day revealed mediastinitis and right hemothorax; open debridement and evacuation were performed. Vacuum-assisted closure was initiated to heal the median incision. The wound gradually cleared, and the vacuum was terminated on the 150th postoperative day. On the 155th postoperative day, the patient suffered a sudden hemorrhage from the anterior thoracic wall. Computed tomography revealed a ruptured ascending aortic pseudoaneurysm surrounding the graft.

Superior vena cava graft infection in thoracic surgery: a retrospective study of the French EPITHOR database

“…To our knowledge, the success of surgical lavage-debridement has not been reported. Two case reports mentioned the success of omentoplasty with graft conservation [ 4 ] or graft removal [ 29 ] due to P. aeruginosa and MRSA graft infection complicated by a pseudoaneurysm of the ascending aorta. Oda et al found decreased 1-year survival in MRSA thoracic aorta graft infection and an omental flap was found to be predictive of hospital mortality [ 16 ].…”

“…To our knowledge, no patients have been reported with late-onset SVCGI who recovered after preservation of the PTFE graft. Thus, graft removal should be reserved for late-onset SVCGI, SVCGI caused by aggressive microorganisms (MRSA , P. aeruginosa or fungi) and recurrence after a surgical graft-sparing strategy in a fit patient or in the presence of associated arterial complications [ 29 ]. If the patient is deemed inoperable, long-term suppressive antibiotherapy could control the infection.…”