T-branch endovascular graft, a good option to treat acute aortic mycotic aneurysm?

Abstract

Background: Complex mycotic aortic aneurysm (MAA) is a rare and life-threatening disease with a high mortality rate. Open surgical treatment has always been considered as gold standard. However, it carries a high mortality and morbidity rate. Endovascular repair is a feasible option with encouraging results, especially in frail patients. Due to the production lead time, Fenestrated/Branched Endovascular Aortic Repair cannot be proposed in urgent cases. In those cases, an alternate solution could be the use of “Off the shelf” (OTS) fenestrated stent grafts. Objective: We aimed to assess the feasibility of OTS fenestrated stent grafts in the acute treatment of a MAA. Methods: We present the case of a frail 74-year-old woman with an acute MAA undergoing a successful treatment by Zenith t-Branch Thoracoabdominal Endovascular Graft associated with antibiotic therapy. Results: Thoraco-abdominal computed tomography (CT) at 1-year follow up showed good result with total exclusion of the thoracic aneurysm and size reduction. No migration of the stent was found, and all branch vessels remained patent. Conclusions: OTS endovascular T-branch is a feasible option to treat acute MAA and could be considered in frail patient. Further studies are required to define the place of this strategy in the management of acute MAA.

Keywords

• Mycotic Aortic Aneurysm
• Endovascular Repair
• Technique