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 (≤ 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.