Direct replacement of mycotic thoracoabdominal aneurysms

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Presentation transcript:

Direct replacement of mycotic thoracoabdominal aneurysms Larry H. Hollier, MD, FACS, FACC, Samuel R. Money, MD, Brian Creely, MD, Thomas C. Bower, MD, Francis J. Kazmier, MD, FACC Journal of Vascular Surgery Volume 18, Issue 3, Pages 477-485 (September 1993) DOI: 10.1016/0741-5214(93)90266-O Copyright © 1993 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

Fig. 1 CT scan demonstrates saccular mycotic aneurysm of thoracoabdominal aorta. Journal of Vascular Surgery 1993 18, 477-485DOI: (10.1016/0741-5214(93)90266-O) Copyright © 1993 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

Fig. 2 Aortogram shows saccular aneurysm of lower thoracic and supraceliac aorta. Note that degenerative changes extend to at least level of midthoracic aorta. Journal of Vascular Surgery 1993 18, 477-485DOI: (10.1016/0741-5214(93)90266-O) Copyright © 1993 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

Fig. 3 Postoperative angiogram shows revascularization after resection of mycotic thoracoabdominal aneurysms in case 1. Proximal anastomosis was performed end to side, followed by distal anastomosis and visceral reconstruction. After revascularization intervening aorta was then excised. Journal of Vascular Surgery 1993 18, 477-485DOI: (10.1016/0741-5214(93)90266-O) Copyright © 1993 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

Fig. 4 Angiogram shows focal changes caused by saccular Salmonella mycotic aneurysms. Journal of Vascular Surgery 1993 18, 477-485DOI: (10.1016/0741-5214(93)90266-O) Copyright © 1993 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

Fig. 5 Angiogram shows patency of aortic and visceral reconstruction with excision of thoracoabdominal Salmonella mycotic aneurysms (case 2). Note patency of graft to intercostal arteries (arrow). Journal of Vascular Surgery 1993 18, 477-485DOI: (10.1016/0741-5214(93)90266-O) Copyright © 1993 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

Fig. 6 Illustration of operative findings (case 3) shows graft erosion of posterior gastric wall with pseudoaneurysm formation and disruption of previous proximal aortic anastomosis. Journal of Vascular Surgery 1993 18, 477-485DOI: (10.1016/0741-5214(93)90266-O) Copyright © 1993 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

Fig. 7 Angiogram of mycotic suprarenal aneurysm secondary to Candida albicans(case 4). Journal of Vascular Surgery 1993 18, 477-485DOI: (10.1016/0741-5214(93)90266-O) Copyright © 1993 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

Fig. 8 Angiogram of suprarenal aorta in patient with mycotic aneurysm secondary to Escherichia coli (case 5). Journal of Vascular Surgery 1993 18, 477-485DOI: (10.1016/0741-5214(93)90266-O) Copyright © 1993 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

Fig. 9 A, Illustration of isolated thoracic mycotic aneurysm. B, Illustration of operative management of isolated mycotic thoracic aneurysm by ascending aorta-to-subdiaphragmatic aortic graft replacement followed by thoracic resection through left chest. Journal of Vascular Surgery 1993 18, 477-485DOI: (10.1016/0741-5214(93)90266-O) Copyright © 1993 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions