Visceral debranching and aortic endoprosthesis for a suspected mycotic pseudoaneurysm of the abdominal aorta involving visceral arteries.

Celiac aortic localization of mycotic pseudoaneurysm is serious. The conventional treatment, resection of infected tissues with in situ revascularization, is associated with a high surgical morbid-mortality rate. We report a case of mycotic pseudoaneurysm of the abdominal aorta involving visceral arteries excluded by an aortic endoprosthesis after visceral debranching. A 69-year-old man developed a celiac mycotic pseudoaneurysm after an acute prostatitis with septicemia (Escherichia coli). He underwent celiac aortic exclusion by an aortic endoprosthesis associated with a retrogade visceral bypass at the same time, under adequate antibiotherapy. Postoperative course was uneventful. After 18-months of follow-up, he was asymptomatic without signs of infection. Hybrid procedure for mycotic celiac aortic pseudoaneurysm seems to be a complementary technique to conventional open repair, especially in emergency. Endovascular approach does not preclude conversion toward conventional surgery, if necessary. This case report raises the matter of aortic endoprosthesis in infected area, the duration of suppressive antibiotherapy, and the conversion in open repair.
(Copyright 2010 Annals of Vascular Surgery Inc. Published by Elsevier Inc. All rights reserved.)