Mycotic aneurysms of the thoracic aorta: Repair with use of endovascular stent-grafts

PURPOSE: Standard therapy of mycotic aneurysms in the descending aorta consists of thoracotomy and in situ graft placement or extraanatomic bypass, The alternative use of endovascular stent-grafts was evaluated for management of infected aneurysms of the thoracic aorta. MATERIALS AND METHODS: In a retrospective analysis during a 5-year period, 112 patients underwent stent-graft placement for thoracic aortic aneurysms, Three patients (mean age, 68.6; range, 64-70 years) had mycotic thoracic aneurysms, Stent-grafts were constructed from Z stents covered with polyester fabric and were delivered remotely through a catheter under fluoroscopic guidance. RESULTS: Complete thrombosis of the mycotic aneurysms was achieved in all patients, One patient required a second separate stent-graft placement procedure because of migration of the initial device; the second patient underwent surgical repair of a ruptured mycotic abdominal aortic aneurysm followed immediately by stent-graft placement for a chronic mycotic thoracic aneurysm; a third patient underwent repair of two infected false aneurysms secondary to complete rupture of a surgical interposition graft, There were no complications of persistent bacteremia despite placement of the stent-graft device at the site of primary infection, reinfection, delayed rupture, paraplegia, distal emboli, or surgical conversion, One patient died of cardiac arrest at 25 months; there were no perioperative deaths (less than or equal to 30 days), The remaining two patients were alive and well at median follow-up of 24 months (range, 4-25 months). CONCLUSION: Endovascular stent-grafts combined with antibiotic therapy may be an alternative to conventional thoracotomy in managing mycotic aneurysms of the descending thoracic aorta.