Suprarenal mycotic aneurysm exclusion using a stent with a partial autologous covering

Purpose. To report a combined endovascular and open technique to manage a s uprarenal mycotic aortic aneurysm using a stent-graft partially covered wit h a section of autologous artery. Methods and Results: A 50-year-old was hospitalized for staphylococcal sept icemia and severe back pain. A previously diagnosed 3-cm abdominal aortic a neurysm was found to have expanded 2 cm in 3 weeks. Aortography documented some periaortic thickening and 2 mycotic aneurysms, one posterior at the le vel of the superior mesenteric artery and the second at the aortic bifurcat ion. After intensive antibiotic therapy, an endovascular approach to exclud e the suprarenal mycotic aneurysm was undertaken in tandem with surgical ex cision of the infrarenal aneurysm. The harvested right common iliac artery was used to partially cover a Palmaz stent, which was deployed under direct vision just above the renal artery ostia so that the coveted portion of th e stent excluded the aneurysm. A right axillofemoral bypass with a femorofe moral bypass completed the revascularization. Postoperatively, the patient developed renal failure, ischemic colitis necessitating a left hemicolectom y, and paraplegia. Although the patient is paralyzed, the aneurysm remains excluded with patent visceral vessels at 12 months following surgery. No or ganisms were grown from excised aortic tissue, and no signs of recurrent in fection have been seen. Conclusions: Stent-graft repair may be able to lessen the invasiveness and reduce the morbidity associated with treatment of mycotic aortic aneurysms.