Repair of Leaking Aortic Pseudoaneurysm due to Sternal Wound Infection in a Patient with CABG and Aorto-Axillary Bypass - A Case Report from Apollo Hospitals Dhaka

Abstract

case of Aorto- axillary bypass graft site with CABG. Surgical intervention gives good result. Methods: A 55 years old gentleman came to our hospital with discharging chest wound with occasional episodes of bleeding through upper chest wound. One and half years back he was operated in another hospital with Aorto-axillary bypass with CABG. CT angiogram showed - Aorto- axillary bypass graft eroding sternum and developed a chronic leak in aortic side. Urgent operation was done on 1.08.13-we went to femoro-femoral bypass first-then very carefully sternotomy was done-found a leak around aortic side of the Aorto-axillary bypass graft. With gentle pressure on leak, proceeded for total circulatory arrest, graft was taken out, found oval shaped opening at ascending aorta, it was repaired by Dacron patch with continuous proline suture. Total circulatory arrest time was 37 minutes. Distal part of the graft on axillary artery found-a silk ligature applied-sternal wound reconstruction was done with pectoral is major muscle flap. Results: The patient remained very well in ICU and was discharged from hospital on 7th post operative day in good general condition. Now more than 1 years follow up he is doing very well. Conclusion: Graft leakage at aortic site of Aorto-axillary bypass graft is not a common entity, surgical intervention with Dacron patch repair gives good outcome. Surgical Repair of aortic pseudoaneurysm a though with high risk, is only remedy to save the life of the patient.