Patent Extra-Anatomic Graft 12 Years after Ascending-Descending Aortic Bypass for Interpositional Graft Infection

A male car driver who sustained polytrauma in a road traffic accident when he was 25 years old, had emergency partial hepatectomy performed for liver laceration, followed by interpositional graft (18 mm woven Dacron) repair for transection of the proximal descending aorta via a left thoracotomy. He also had multiple fractures which were treated conservatively. His postoperative recovery was complicated by bilateral MRSA empyema necessitating cope loop drainage and a large MRSA-infected sacral sore requiring a rotational flap and a total of 6 months of intravenous Vancomycin. He was presented with hemoptysis 3 years later. Aortography revealed a leak at the distal end of the aortic interpositional graft, which had resulted in a pseudoaneurysm and an aortobronchial fistula. The leak was successfully occluded with a 22 mm × 131 mm Talent stent graft (Medtronic AVE, Santa Rosa, Calif) via an endovascular approach. He subsequently developed MRSA septicemia which was treated with several months of antibiotics. His hemoptysis recurred 2 years later due to a recurrent leak from the distal end of the previous graft. Emergency extra-anatomic ascending aorta to descending aorta bypass by using a 16 mm woven Dacron graft was performed via a posterior pericardial approach through median sternotomy (Figure 1).