Successful Repair of Critical Anastomotic Bleeding after Surgery for Ruptured Infected Thoracic Aortic Aneurysm

(Depertment of Cardiac Surgery, The Jikei University School of Medicine, Tokyo, Japan)

Takahiro Inoue Kazuhiro Hashimoto Yoshimasa Sakamoto
Michio Yoshitake Hirokuni Naganuma Noriyasu Kawada
Gen Shinohara Toshiyuki Hoshina Koichi Muramatsu
Infected aortic aneurysm is very difficult to treat and is associated with a high mortality rate. A 78-year-old man had been scheduled to undergo selective endovascular repair for distal aortic arch aneurysm. While standby, however, he was admitted to our emergency room because of hemoptysis. Rapid dilatation of the aneurysm shown on serial CT and elevated of inflammatory reactions yielded a diagnosis of infected aortic aneurysm. Because the aneurysm had ruptured into the left lung, emergency surgery was performed. Six days after the first operation, critical bleeding due to anastomotic disruption of the distal aorta caused by infection and subsequent cardiac arrest occurred. We immediately started open chest massage and controlled the bleeding manually in the ICU, while an operating room was prepared. In the redo operation, anastomotic disruption was repaired using the visceral pleura under deep hypothermic circulatory arrest. Anastomotic bleeding is a potentially life-threatening condition, therefore extremely prompt measures are vital. Appropriate management based on the assumption of anastomotic bleeding was very important in the postoperative course of this case of infectious aortic aneurysm.
  Jpn. J. Cardiovasc. Surg. 39:335-338(2010)

Keywords:ruptured thoracic aortic aneurysm, infected aortic aneurysm, anastomotic bleeding