Michael Hessinger

Endovascular Treatment of Mycotic Aortic Pseudoaneurysms with Stent-Grafts

Mycotic aortic aneurysms remain a therapeutic challenge, especially in patients who are not suitable for open surgery. Endovascular treatment with stent-grafts in this indication is still disputed. Between January 2002 and January 2006, six patients with mycotic aneurysms of the thoracoabdominal or abdominal aorta were admitted to our department. All patients were male, aged 57–83 years (mean, 74.6 years). The mycotic aneurysms were diagnosed on the basis of clinical signs of infection, on CT, and, in four cases, on a positive blood culture. In all patients the mycotic aortic aneurysms were treated endovascularly by stent-graft implantation. Technical and clinical success was achieved in all patients. There was no in-hospital or 30-day mortality. In the follow-up period (range, 2–47 months) four patients died of cancer, cardiac failure, or unknown cause (one case). Two patients are still alive with nearly complete regression of the aneurysms. We conclude that treatment of mycotic aortic aneurysms with stent-grafts may be an alternative in selected patients.

Der extraanatomische transiliakale Bypass

ZusammenfassungInfektionen in der Leiste nach alloplastischer Gefäßrekonstruktion stellen unverändert eine Herausforderung für den Gefäßchirurgen dar. Bei einem 48-jährigen Patienten kam es nach Anlage eines Obturatorbypasses wegen Tumorresektion in der linken Leiste zu einer Protheseninfektion. Die operative Sanierung erfolgte durch die Anlage eines extraanatomischen Bypasses transossär durch die Beckenschaufel mit sekundärer Explantation der infizierten Gefäßprothesen. Bei ausgedehnten Infektionen beziehungsweise Weichteilschädigung der Leiste oder des kleinen Beckens durch Trauma, Voroperationen oder Tumorbestrahlung stellt der transiliakale Bypass eine einfache und sichere Alternative dar.AbstractInfections of the groin following alloplastic vascular reconstruction still remain a challenge for the vascular surgeon. In a 48-year-old patient who underwent an extra-anatomic obturator bypass for tumor resection of his left groin, a graft infection occurred. Healing was achieved by performing a new extra-anatomic bypass transosseously through the iliac wing with secondary explantation of the infected grafts. In the case of severe infections or injured tissue in the groin or small pelvis caused by trauma, prior operations or radiation therapy, a transiliac bypass is a simple and safe alternative.