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| Content Provider | Springer Nature : BioMed Central |
|---|---|
| Author | Matsushima, Hirokazu Ishimine, Tohru Taniguchi, Naoki Tengan, Toshiho |
| Abstract | Background Open thoracic surgery (with infected lesion removal, prosthetic graft replacement, and pedicled tissue flap) has remained the main treatment for infected thoracic aortic aneurysms to date. Recent reports have highlighted good prognostic outcomes with thoracic endovascular aortic repair. However, thoracic endovascular aortic repair for infected thoracic aortic aneurysms is associated with an exacerbation of infection due to residual infected tissues. We discuss the control of refractory infections following endovascular treatment of infected thoracic aortic aneurysms. Case presentation An 81-year-old man, with a history of insulin-dependent diabetes mellitus and pancreaticoduodenectomy, presented to our emergency department with a fever. Blood tests revealed a markedly elevated leukocyte count, and contrast-enhanced computed tomography suggested a descending thoracic aortic pseudoaneurysm. We diagnosed the patient with an infected descending thoracic aortic aneurysm, and performed urgent thoracic endovascular aortic repair; he was started on an intravenous antibiotic treatment. Postoperatively, blood tests revealed a decreased leukocyte count and the patient remained afebrile. However, computed tomography revealed temporal enlargement of the abscess cavity; therefore, an abscess debridement and stent graft wrapping with pedicled latissimus dorsi muscle flaps were performed, which successfully controlled the infection. Six weeks after abscess debridement, the patient was switched to an oral antibiotic therapy. There was no evidence of recurrence of infection 8 months after the surgery. Conclusions A combined abscess debridement and pedicled tissue flap approach is useful for patients with poor surgical tolerance in whom infection control is difficult after thoracic endovascular aortic repair for infected thoracic aortic aneurysms. Pedicled latissimus dorsi muscle flaps are useful when using the omentum for pedicled tissue flap is difficult. |
| Related Links | https://cardiothoracicsurgery.biomedcentral.com/counter/pdf/10.1186/s13019-023-02155-y.pdf |
| Ending Page | 6 |
| Page Count | 6 |
| Starting Page | 1 |
| File Format | HTM / HTML |
| ISSN | 17498090 |
| DOI | 10.1186/s13019-023-02155-y |
| Journal | Journal of Cardiothoracic Surgery |
| Issue Number | 1 |
| Volume Number | 18 |
| Language | English |
| Publisher | BioMed Central |
| Publisher Date | 2023-02-02 |
| Access Restriction | Open |
| Subject Keyword | Cardiac Surgery Thoracic Surgery Infected thoracic aortic aneurysm Thoracic endovascular repair Latissimus dorsi muscle flaps Stent-graft wrapping |
| Content Type | Text |
| Resource Type | Case study |
| Subject | Surgery Cardiology and Cardiovascular Medicine Pulmonary and Respiratory Medicine |
| Journal Impact Factor | 1.5/2023 |
| 5-Year Journal Impact Factor | 1.6/2023 |
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