Neoaortoiliac system buttressed with tensor fascia lata for treatment of juxtarenal mycotic aortic aneurysm

Abstract

A 50-year-old man presented with abdominal pain and high-grade fever for 3 months and was diagnosed to have juxtarenal saccular abdominal aortic aneurysm and superior mesenteric artery stenosis on imaging (A). He was diabetic and a chronic smoker. Blood and urine culture specimens had grown group D Salmonella. Open repair of the mycotic aneurysm was done with a neoaortoiliac system using bilateral superficial femoral veins and autologous tensor fascia lata to reinforce the proximal anastomotic line (B and C). The patient was also prescribed long-term antibiotic therapy. The postoperative period was uneventful except for mild lymphorrhea from bilateral thigh wounds that subsided by 1 week. He was discharged on postoperative day 11 with normal pedal pulses and preserved renal function. On 3-month follow-up, the patient is doing well and is asymptomatic. Follow-up computed tomography showed intact anastomoses with good flow through the vein graft (D/Cover). The patient gave informed consent for publication of images and details of the case. Femoropopliteal vein conduit to reconstruct the aortoiliac vasculature has excellent long-term durability and is resistant to infection, which makes it a useful treatment option in cases of mycotic aneurysm.1Bernatchez J. Gauvin V. Gilbert N. Rhéaume P. Long-term results of the neoaortoiliac system procedure for aortic graft infections and mycotic aneurysms: a single-center experience.J Vasc Surg. 2016; 64: 1544Abstract Full Text Full Text PDF Google Scholar Autologous tensor fascia lata was used to buttress the proximal anastomotic line as the posterior aortic wall at the anastomosis was diseased; it will also minimize the risk of infection compared with synthetic felt pledget. Salmonella is associated with persistent and extended infection, and the virulence of the organism involved is to be considered in planning endovascular aneurysm repair. Endovascular management with fenestrated endovascular aneurysm repair should be considered only in select critically ill patients with complex mycotic aneurysms in whom surgical management is too risky, considering the high risk of persistent infection and associated complications after the procedure.2Sörelius K. Mani K. Björck M. Nyman R. Wanhainen A. Endovascular repair of mycotic aortic aneurysms.J Vasc Surg. 2009; 50: 269-274Abstract Full Text Full Text PDF PubMed Scopus (69) Google Scholar Because our patient was young and otherwise healthy, we opted for open repair of the aneurysm. Limiting the extent of femoral vein harvest to the adductor canal, as in this case, will help in reducing the risk for development of compartment syndrome in the postoperative period as it will preserve the profunda vein and popliteal genicular draining veins.