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Prosthetic vascular graft infection in the thoracic aortic area is a rare but serious complication. Adequate management of the complication is essential to increase the chance of success of open surgery. While surgical site infection is suggested as the root cause of the complication, it is also related to decreased host tolerance, especially as found in elderly patients. The handling of prosthetic vascular graft infection has been widely discussed to date. This paper mainly provides a summary of literature reports published within the past 5 years to discuss issues related to multidisciplinary treatment approaches, including surgical site infection, timing of onset, diagnostic methods, causative pathogens, auxiliary diagnostic methods, antibiotic treatment, anti-infective structures of vascular prostheses, surgical treatment, treatment strategy against infectious aortic aneurysms, future surgical treatment, postoperative systemic therapy, and antimicrobial stewardship. A thorough understanding of these issues will enable us to prevent prosthetic vascular graft infection in the thoracic aortic area as far as possible. In the event of its occurrence, the early introduction of appropriate treatment is expected to cure the disease without worsening of the underlying pathological condition.

The artery and vein of the transplanted kidney are generally anastomosed to the external iliac artery and vein, respectively. Therefore, in open abdominal artery aneurysm (AAA) repair in renal transplant patients, kidney ischemia due to a proximal aortic clamp is a serious problem. We successfully performed endovascular aneurysm repair (EVAR) of AAA without aortic clamping in two renal transplant recipient cases. The two patients were diagnosed with large AAAs following the renal transplant, and EVAR was performed. To protect the renal function, we used N-acetylcysteine premedication and hydration before the operation, and we could then reduce the iodine contrast medium by using echography of the artery during the operation. In this report, a case where EVAR with renal function protection is a useful treatment for renal transplant recipients with AAA is described.

Subjects: Currently, hemostatic materials made from human blood components and animal-derived collagen is used for controlling operative hemorrhage in the cardiovascular surgery field. In this study, we focused on an entirely synthetic self-assembling peptide (development code: TDM-621) that gels when in contact with blood or other bodily fluids and stops bleeding upon contact with a wound site. We investigated its usefulness as a hemostatic material in animal and clinical studies., Methods: Before we began the clinical study, we demonstrated the hemostasis efficacy and safety of TDM-621 in animal experimental models. Twenty-five patients (22 men, 3 women) were enrolled in the clinical study, and the following procedures were performed: 1) coronary artery bypass graft (CABG) (n = 9), 2) abdominal aortic graft replacement (n = 4), and 3) peripheral artery bypass (n = 12). The TDM-621 material was applied to a total of 33 vascular anastomotic graft sites (some patients received material at more than one site). Both hemostatic efficacy and safety were examined., Results: A total of 33 anastomotic graft sites in 25 patients were evaluated, and the averaged primary and secondary efficacy rate was 94.5%. No postoperative bleeding or adverse events (including serious adverse events) with a causal relationship to treatment were observed., Conclusion: This study indicated that TDM-621 is a more effective and reliable hemostat than commonly-used general hemostatic agents and, therefore, will be very useful in several cardiovascular surgery applications.

The patient was a 59-year-old female. Because of massive hemoptysis, she was brought to our emergency center by ambulance. Thoracic computed tomography led to a diagnosis of an infectious thoracic aortic pseudoaneurysm accompanied by an aortobronchopulmonary fistula. Emergency surgery followed. Also noted was an advanced hepatic dysfunction, assessed as Child-Pugh score B, caused by an alcoholic liver disease. A localized affected area made it possible for us to perform an aneurysmectomy using a temporary bypass rather than assisted circulation. A patch plasty using expanded polytetrafluoroethylene completed the procedure. Streptococcus agalactiae (GBS) was detected in a sample obtained during the surgery from an abscess located in the aneurysm. The patient made satisfactory postoperative progress and left the hospital walking unaided on the 36th postoperative day.

The occurrence of mediastinitis following synthetic vascular replacement surgery is still associated with an unfavorable prognosis in the treatment of thoracic aortic diseases. This time we report a Bentall procedure that we re-performed to treat an aortic root pseudoaneurysm, which developed after a postoperative mediastinitis. This followed the first Bentall procedure, which was treated by debridement of the focus of infection, continuous lavage, and a two-step rectus abdominis muscle flap implantation. Implantation of a rectus abdominis muscle flap is effective in controlling infection in the treatment of mediastinitis after heart surgery. However, after synthetic vascular replacement surgeries have been performed to treat aortic diseases, especially after aortic root reconstruction surgery, which puts stress on the anastomotic site, consideration should be given regarding the development of hemorrhages and pseudoaneurysms as a result of infection-induced tissue fragilization.

A 63-year-old man had undergone graft replacement of the descending aorta due to dissection of aortic aneurysm nine years before and closure of an aortobronchopulmonary fistula two years before. He was admitted to our hospital because of massive hemoptysis. Angiography and chest computed tomography (CT) revealed a pseudoaneurysm on the proximal end caused by graft detachment. Intravascular ultrasound clearly revealed half round detachment on both ends of the graft. Replacement of the ascending, arch and distal aorta including the graft was performed, and the patient's postoperative course has been satisfactory. We have concluded that intravascular ultrasound is a useful method for detecting pseudoaneurysm after graft replacement which is not evident on cineangiography, CT or distal subtraction angiography.