A Case of Infected Endograft Explanation Following Thoracic Endovascular Aortic Repair for Distal Anastomotic Infectious Pseudoaneurysm after Total Arch Replacement

We report a case of semi-urgent infected endograft explanation following thoracic endovascular aortic repair (TEVAR) for distal anastomotic (DA) infectious pseudoaneurysm after total arch replacement (TAR). A 70-year-old male underwent TAR for distal arch saccular aneurysm 10 years before and open bifurcated graft replacement for an abdominal aortic aneurysm 5 years before. The patient was admitted 3 years before because of repeated pyrexia of 40°C. Contrast-enhanced CT scans revealed suspected vegetation and infectious pseudoaneurysm at the DA of the TAR, and semi-urgent TEVAR was performed on the next day. Antibiotic therapy was initiated for Staphylococcus capitis detected in a blood culture, and the patient was discharged after a negative blood culture. At this time, he was admitted owing to face and below-knee edema and dyspnea. Because a blood culture identified Methicillin-resistant Staphylococcus capitis and antibiotic therapy uncontrolled infection, we performed explanation of the infected endograft and distal end of the TAR graft and replacement of the descending thoracic aorta with a rifampicin-bonded graft under moderate hypothermic circulatory arrest with retrograde cerebral perfusion via the 4th intercostal posterolateral thoracotomy. Postoperative 6-week antibiotic therapy was continued and the patient was discharged in good condition after a negative blood culture on postoperative day 46.