Novel extra-anatomic intra-abdominal reconstruction for treatment of paravisceral aortic infection

Abstract

Adequate treatment of native or prosthetic aortic infection requires extensive surgical debridement and establishing flow to the extremities using extra-anatomic or in situ reconstruction, each with its inherent limitations. Infection of the paravisceral aortic segment precludes an axillofemoral bypass as the sole treatment because of inability to provide visceral perfusion. In situ autograft or allograft reconstructions could be limited by conduit availability or significantly prolonged operative time, or both. Placement of an antibiotic-soaked prosthetic in a field with gross purulence carries a high risk of reinfection. We describe a technique for extra-anatomic, intra-abdominal reconstruction using an antibiotic-soaked prosthetic graft to avoid the infected paravisceral aortic bed and achieve antegrade lower extremity and visceral vessel perfusion.

Late Leakage of the Aortic Stump After Removal of an Infected Graft

“…In order to suture the aorta in the uncontaminated supramesocolic space, a 3-branched extra-anatomic aortovisceral bypass was performed. The use of an extra-anatomic reconstruction to treat paravisceral aortic infection has already been described with either retrograde 4 or antegrade 5 approach, however, not in case of stump disruption. We think that this technique should be the standard of care for the treatment of disrupting stumps, in order to minimize the risk of intraoperative blowout and postoperative reinfection.…”