Graft for Mycotic Thoracic Aortic Aneurysm: Omental Wrapping to Prevent Infection

Abstract

Nine cases of mycotic thoracic aortic aneurysm were treated surgically between July 1995 and March 2003. The aneurysms were located in the ascending aorta in 1 patient, the descending thoracic aorta in 5, and the thoracoabdominal aorta in 3. Preoperatively, 3 patients were in shock due to rupture of the aneurysm. All patients underwent aneurysmectomy and in-situ graft placement. In 5 patients, the graft was covered with a pedicled omental flap to prevent postoperative graft infection. There were 2 hospital deaths: one patient died of multi-organ failure, and the other died from intrathoracic bleeding. After discharge, one patient died from intrathoracic bleeding 3 months after surgery. These 3 patients had not received omental wrapping. Postoperative graft infection did not occur in the 6 surviving patients during a mean follow-up period of 4.0 +/- 3.1 years. It was concluded that covering the prosthetic graft with a pedicled omental flap may help prevent postoperative graft infection and improve the surgical results.

Mycotic Abdominal Aneurysm Caused by Campylobacter Fetus: A Case Report for Surgical Management

“…While extra-anatomical bypass was commonly performed in the past, anatomic reconstruction, resection of aneurysm wall, and covering of the prosthetic graft with omental wrapping have been introduced with favorable outcomes. 14,15) In our case, we selected in-situ prosthetic graft replacement because pus discharge was not observed during surgery. We considered omental wrapping; however, the omentum was severe atrophied from the inflammation, and we could not perform the procedure.…”

Use of omental pedicles in mycotic abdominal aortic aneurysm repair

“…There is an increased risk of rupture and of postoperative graft infections. 3 In addition, aortic infection complicated by psoas abscess is associated with higher incidence of emergency operation, hospital mortality, prosthetic graft infection, and aneurysm-related mortality than infection without an accompanying psoas abscess. 4 There are few previously cases of aortic infection complicated by a psoas abscess and the incidence of psoas abscess in patients with a mycotic aortic aneurysm has been reported at 4-20%.…”

In situ graft replacement and rectus abdominis muscle flap transfer for infected thoracoabdominal aortic aneurysm after gastrectomy

“…Kuniyoshi et al reported nine cases of infected thoracic or thoracoabdominal aneurysms, 3 and three of their patients died of infection-related reasons; two of the patients did not receive the omental fl ap transfer because of previous gastrectomy. Because rupture of the anastomotic site of graft replacement was the cause of their death, Kuniyoshi concluded that it was important to use the omental fl ap to prevent recurrence of infection.…”