First in Man Explanation of Thoracic Branched Endograft for Infection
Presented During:
Thursday, April 25, 2024: 5:38PM - 7:00PM
Sheraton Times Square
Posted Room Name:
Central Park
Abstract No:
P0139
Submission Type:
Abstract Submission
Authors:
Fabian Jimenez Contreras (1), Griffin Stinson (1), Patrick Kohtz (1), Brian Gilmore (2), Gilbert Upchurch (2), Tomas Martin (1)
Institutions:
(1) Department of Surgery, Division of Thoracic and Cardiovascular Surgery, University of Florida, Gainesville, FL, (2) Department of Surgery, Division of Vascular Surgery, University of Florida, Gainesville, FL
Submitting Author:
Fabian Jimenez Contreras
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Department of Surgery, Division of Thoracic and Cardiovascular Surgery, University of Florida
Department of Surgery, Division of Thoracic and Cardiovascular Surgery, University of Florida
Co-Author(s):
Griffin Stinson
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Department of Surgery, Division of Thoracic and Cardiovascular Surgery, University of Florida
Department of Surgery, Division of Thoracic and Cardiovascular Surgery, University of Florida
Patrick Kohtz
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Department of Surgery, Division of Thoracic and Cardiovascular Surgery, University of Florida
Department of Surgery, Division of Thoracic and Cardiovascular Surgery, University of Florida
Brian Gilmore
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Department of Surgery, Division of Vascular Surgery, University of Florida
Department of Surgery, Division of Vascular Surgery, University of Florida
Gilbert Upchurch
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Department of Surgery, Division of Vascular Surgery, University of Florida
Department of Surgery, Division of Vascular Surgery, University of Florida
*Tomas Martin
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Department of Surgery, Division of Thoracic and Cardiovascular Surgery, University of Florida
Department of Surgery, Division of Thoracic and Cardiovascular Surgery, University of Florida
Presenting Author:
Fabian Jimenez Contreras
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Abstract:
Objective: The GORE TAG Thoracic Branched Endoprosthesis (TBE, WL Gore & Associates, Flagstaff AZ) received FDA approval in May 2023 and remains the only branched thoracic stent graft available in the US. As the use of TBE expands it can be expected that management of complications from this device will become increasingly important. We present here the first reported case of explantation of an infected TBE.
Methods: A 67-year-old male underwent placement of a TBE for contained rupture of the distal aortic arch and thoracic aorta. Two weeks following his initial presentation he re-developed chest pain and was found to have a type 1a endoleak prompting proximal extension of his endograft. Following this re-intervention he developed imaging evidence concerning for a mycotic aneurysm which had not been noted at the time of his initial surgery. The mycotic portion of the aneurysm eroded into the left lower lobe that resulted in hemoptysis. This required resection of his left upper lobe and ultimately prompting transfer to a quaternary care aortic center.
Results: In order to remove the TBE a left common carotid to subclavian artery bypass was performed. The patient was then repositioned into the right lateral decubitus position, cannulated for cardiopulmonary bypass and placed in deep hypothermic circulatory arrest. The patient's aneurysm was explored and the main aortic component was removed (Figure 1). A large abscess involving the distal arch, at base of the left subclavian artery, was explored and the subclavian stent component was explanted. The aorta was reconstructed with a 28 mm rifampin-soaked dacron graft with anastomoses in zone 2 and zone 5. The subclavian artery was ligated. Two additional washouts were required before an omental flap was used to obtain coverage of the aortic graft on post-operative day (POD) 6. As operative cultures grew methicillin-resistant Staphylococcus aureus the patient was treated with a course of vancomycin followed by suppressive doxycycline. After an otherwise uncomplicated course the patient was discharged on POD 18.
Conclusions: Explantation of an infected TBE is feasible with multidisciplinary care at an experienced aortic center.
Methods: A 67-year-old male underwent placement of a TBE for contained rupture of the distal aortic arch and thoracic aorta. Two weeks following his initial presentation he re-developed chest pain and was found to have a type 1a endoleak prompting proximal extension of his endograft. Following this re-intervention he developed imaging evidence concerning for a mycotic aneurysm which had not been noted at the time of his initial surgery. The mycotic portion of the aneurysm eroded into the left lower lobe that resulted in hemoptysis. This required resection of his left upper lobe and ultimately prompting transfer to a quaternary care aortic center.
Results: In order to remove the TBE a left common carotid to subclavian artery bypass was performed. The patient was then repositioned into the right lateral decubitus position, cannulated for cardiopulmonary bypass and placed in deep hypothermic circulatory arrest. The patient's aneurysm was explored and the main aortic component was removed (Figure 1). A large abscess involving the distal arch, at base of the left subclavian artery, was explored and the subclavian stent component was explanted. The aorta was reconstructed with a 28 mm rifampin-soaked dacron graft with anastomoses in zone 2 and zone 5. The subclavian artery was ligated. Two additional washouts were required before an omental flap was used to obtain coverage of the aortic graft on post-operative day (POD) 6. As operative cultures grew methicillin-resistant Staphylococcus aureus the patient was treated with a course of vancomycin followed by suppressive doxycycline. After an otherwise uncomplicated course the patient was discharged on POD 18.
Conclusions: Explantation of an infected TBE is feasible with multidisciplinary care at an experienced aortic center.
Aortic Symposium:
Aortic Arch
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