Cor Vasa 2019, 61(5):519-523 | DOI: 10.1016/j.crvasa.2018.06.002

(Infected thoracic stentgraft and prosthetic graft with replacement by human aortic allograft)

Vladimír Sihotský^a, Peter Berek^a, Abraham John Mathews^b, Ivan Kopolovets^a, Mária Kubíková^a, František Sabol^c, Adrián Kolesár^c, Ľuboslav Beňa^d, Ján Rosocha^e, Mária Frankovičová

^a Klinika cievnej chirurgie, Lekárska fakulta Univerzity Pavla Jozefa Šafárika a Východoslovenský ústav srdcových a cievnych chorôb a.s., Košice, Slovensko

^b Department of Colorectal and HPB Surgery, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, Velká Británie

^c Klinika srdcovej chirurgie, Lekárska fakulta Univerzity Pavla Jozefa Šafárika a Východoslovenský ústav srdcových a cievnych chorôb a.s., Košice, Slovensko

^d Transplantačné oddelenie, Univerzitná Nemocnica L. Pasteura, Košice, Slovensko

^e Združená tkanivová banka, Univerzitná Nemocnica L. Pasteura, Košice, Slovensko

Background: We describe a case of successful replacement of an infected thoracic stentgraft and a prosthetic aortic graft with human aortic allograft. Case presentation: The patient was a forty-seven years old male who had an operation for aortic coarctation previously. The procedure was bypass grafting of the descending thoracic aorta from the point of coarctation to infrarenal abdominal aorta. He developed a false aneurysm in the proximal anastomosis of the bypass after thirty years. The false aneurysm was first treated by implanting of thoracic stentgraft. In eight months after implantation signs of an infection of the stentgraft developed. We performed explantation of the entire artificial material, including the thoracic stentgraft and also former prosthetic dacron graft. Infected descending aorta was replaced by in situ aortic allograft. The patient is remaining well with no sign of sepsis, claudication or visceral ischemia at the moment.

Keywords: Human aortic allograft, Infected prosthetic graft, Infected stentgraft, Conclusion: Explantation of the entire artificial material is the treatment of choice in cases of infected stentgrafts. Replacement with aortic allograft is the best described option of the treatment of infected prosthetic grafts or stentgrafts in the descending and thoracoabdominal aorta. The complications of allograft replacement can be aneurysmatic dilatation or stenosis and occlusion of the graft. The operative mortality of these operations remains still high, up to 30%. Despite its high mortality surgical treatment of prosthetic graft infection is mandatory because untreated patients almost always die.

Published: October 20, 2019  Show citation