ORIGINAL ARTICLE   

Chirurgia 2019 December;32(6):318-23

DOI: 10.23736/S0394-9508.18.04943-4

Copyright © 2018 EDIZIONI MINERVA MEDICA

lingua: Inglese

Changes in the surgical strategy for mycotic thoracic aortic aneurysms: the potential role of omental wrapping to prevent infection after thoracic endovascular aortic repair

Satoshi YAMASHIRO ✉, Ryoko ARAKAKI, Yuya KISE, Hitoshi INAFUKU, Takaaki NAGANO, Yukio KUNIYOSHI

Department of Thoracic and Cardiovascular Surgery, Graduate School of Medicine, University of the Ryukyus, Okinawa, Japan

BACKGROUND: Traditionally, surgical resection with extensive debridement and artificial thoracic aortic graft implantation has been the gold standard management for mycotic thoracic aortic aneurysms (MTAA). However, some patients with MTAA are considered unsuitable for radical surgery because of old age and the presence of severe and multiple comorbidities. In more recent years, we have successfully performed omental wrapping followed by thoracic endovascular aortic repair (TEVAR) for MTAA. In this report, we discuss about potential of TEVAR as definitive treatment for MTAA.
METHODS: This study included 10 high-risk patients (men, N.=7; mean age, 74.0±10.6 years) with MTAA who were treated by TEVAR at our institution between January 2012 and December 2017. Their MTAA were located in the arch (N.=6), descending aorta (N.=3), and thoracoabdominal aorta (N.=1).
RESULTS: Two patients died in the hospital (operative mortality, 20.0%). The other two patients required additional aortic fenestration with omentopexy due to residual infection after TEVAR. Four patients include two patients who received omental wrapping died of causes not related to the aneurysm during the follow-up period. One patient required computed tomography-guided drainage for mediastinitis due to esophageal perforation late after TEVAR.
CONCLUSIONS: Although TEVAR has not been shown to have a beneficial long-term survival, postoperative infection can be well-controlled. TEVAR has the potential to be a definitive treatment modality in high-risk MTAA patients. Omental flap wrapping of implanted artificial aortic grafts during TEVAR, as well as open surgery, could prevent or reduce the occurrence of subsequent infection.

KEY WORDS: Aortic aneurysm, thoracic; Mycoses; Endovascular procedures