European Journal of Cardio-Thoracic Surgery, Vol 1, 59-62, Copyright © 1987 by European Association for Cardio-thoracic Surgery
Emergency treatment of rupture of the proximal anastomosis of an infected thoracoabdominal aortic graft with bleeding into a postpneumonectomy empyema cavity
S Larsson and S Svensson
Department of Thoracic and Cardiovascular Surgery, Sahlgrenska Sjukhuset, Goteborg, Sweden.
The thoracic part of a huge thoracoabdominal aortic aneurysm was resected.
A prosthetic graft was implanted between the descending aorta and the iliac
arteries. The celiac, superior mesenteric, and the renal arteries were
connected to the aortic prosthesis with two bifurcation grafts. A
life-threatening hemorrhage into an empyema cavity occurred
postoperatively. An emergency two-stage procedure was employed involving:
(1) exclusion of the infected intrathoracic segment and exclusion of an
infected sutured aortic stump; (2) subsequent removal of necrotic and
infected tissue, including the excluded segment of the aorta and the graft
in a second operation. The patient recovered and is now well and works
full-time. Angiography 3 years after the operation shows that all
anastomoses are patent. A scheme of management of these rare cases is
proposed.
