Abstract
BackgroundMycotic thoracic aortic aneurysm is an extremely rare but serious disease because it can easily rupture and has a high mortality rate. The standard therapy for it comprises graft replacement and debridement using systemic antibiotics; nonetheless, this has a high mortality rate and complications. Endovascular aortic repair is considered a bridging therapy before open surgery. However, we have used it at our institution for the radical treatment of mycotic thoracic aortic aneurysm utilizing pyoktanin (methylrosanilide chloride)-applied devices. Thus, the aim of this study was to report our clinical experience with pyoktanin-applied thoracic endovascular aortic repair for the treatment of mycotic thoracic aortic aneurysm, including its effects.MethodsFrom April 2017 to July 2019, we performed thoracic endovascular aortic repair using pyoktanin for eight cases of mycotic thoracic aortic aneurysm using Valiant®. During device preparation before insertion, pyoktanin was flushed from the side port instead of saline containing heparin.ResultsThere were no operative deaths, recurrences of infection, or major complications. Two cases died from pneumonia and cancer; the other six cases were alive during the follow-up period.ConclusionsPyoktanin-applied thoracic endovascular aortic repair for mycotic thoracic aortic aneurysm treatment is effective. However, the appropriate use of antibiotics and bundled therapy is necessary at present.
Highlights
Mycotic thoracic aortic aneurysm is an extremely rare but serious disease because it can rupture and has a high mortality rate
Because the above-described problem of device infection remains, pyoktanin is applied to our graft prior to insertion to prevent infection. This technique has been used in all mycotic thoracic aortic aneurysm (MTAA) cases in our institution, and all patients have survived at least 15 months after Thoracic endovascular aortic repair (TEVAR), implying that pyoktanin renders a certain amount of protection against device infection
We use pyoktanin at our institution when surgical graft or stent-graft is used at the site of infection, as we have found that the sustained efficacy for RFP is poor when surgical graft or stent-graft is used for MTAA
Summary
Mycotic thoracic aortic aneurysm is an extremely rare but serious disease because it can rupture and has a high mortality rate. We have used it at our institution for the radical treatment of mycotic thoracic aortic aneurysm utilizing pyoktanin (methylrosanilide chloride)-applied devices. Thoracic endovascular aortic repair (TEVAR), a relative contraindication for MTAA, has previously been performed as a bridge therapy before open surgery or as an emergency. Because the above-described problem of device infection remains, pyoktanin (methylrosanilide chloride) is applied to our graft prior to insertion to prevent infection. Far, this technique has been used in all MTAA cases in our institution, and all patients have survived at least 15 months after TEVAR, implying that pyoktanin renders a certain amount of protection against device infection
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