Repair of complex mycotic aneurysm with multiple parallel stent grafts using an endovascular approach

Abstract

Background: Endovascular repair of mycotic aneurysms is a viable option in patients deemed high risk for open repair, with complex repair using parallel stent grafting described in cases of both mycotic thoracic aneurysms as well as mycotic para-visceral abdominal aneurysms. We present the case of a mycotic suprarenal aneurysm with endovascular repair including combined proximal and distal 4-vessel parallel stent grafting. Case Report: The patient is a 76-year-old male who presented with malaise, back pain, fever, and chills. Work-up was pertinent for leukocytosis and blood cultures positive for Group B streptococcus. Computed tomography (CT) imaging revealed a suprarenal mycotic aneurysm extending from the origin of the superior mesenteric artery to the bilateral renal arteries, as well as associated periaortic and retroperitoneal fat stranding. Aorta proximal and distal to the aneurysm was normal. We performed an endovascular repair using a 10-centimer length, 31 to 26 mm tapered thoracic stent graft. Parallel grafts were placed from proximal approach into the celiac and superior mesenteric arteries, and from distal approach into bilateral renal arteries using balloon-expandable covered stents. His-postoperative course was unremarkable, and he was discharged on the second post-operative day. He completed a six-week course of intravenous antibiotics and continues oral antibiotics for long-term prophylaxis. At the four-year follow-up, he remained asymptomatic with CT imaging showing patent stent grafts without evidence of endoleak. Conclusions: Complex endovascular repair of mycotic aneurysms using a combination of a thoracic covered stent and parallel stent grafts extending from both proximal and distal approaches can be a viable alternative in selected patients deemed high risk for open repair. Further follow-up will be needed to determine long-term outcomes.

Keywords

• Endovascular
• Mycotic aneurysm
• Parallel stents
• Suprarenal aneurysm
• Snorkel grafts
• Periscope grafts