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Graft for Mycotic Thoracic Aortic Aneurysm: Omental Wrapping to Prevent Infection

Second Department of Surgery, Faculty of Medicine, University of the Ryukyus, Okinawa, Japan

For reprint information contact: Yukio Kuniyoshi, MD Tel: 81 98 895 1168 Fax: 81 98 895 1422 Email: kuni9244{at}med.u-ryukyu.ac.jp, Second Department of Surgery, Faculty of Medicine, University of the Ryukyus, 207 Uehara Nishihara-cho, Okinawa 903-0215, Japan.

Nine cases of mycotic thoracic aortic aneurysm were treated surgically between July 1995 and March 2003. The aneurysms were located in the ascending aorta in 1 patient, the descending thoracic aorta in 5, and the thoracoabdominal aorta in 3. Preoperatively, 3 patients were in shock due to rupture of the aneurysm. All patients underwent aneurysmectomy and in-situ graft placement. In 5 patients, the graft was covered with a pedicled omental flap to prevent postoperative graft infection. There were 2 hospital deaths: one patient died of multi-organ failure, and the other died from intrathoracic bleeding. After discharge, one patient died from intrathoracic bleeding 3 months after surgery. These 3 patients had not received omental wrapping. Postoperative graft infection did not occur in the 6 surviving patients during a mean follow-up period of 4.0 ± 3.1 years. It was concluded that covering the prosthetic graft with a pedicled omental flap may help prevent postoperative graft infection and improve the surgical results.