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Case Reports
. 2019 Apr 28;5(2):139-142.
doi: 10.1016/j.jvscit.2018.12.012. eCollection 2019 Jun.

Preservation of renal perfusion by hepatorenal and splenorenal bypasses before explantation of an infected abdominal aortic endograft

Brandon Neil Glousman  1 , Robyn Macsata  1 , Jillian Catalanotti  2 , Shawn Sarin  3 , Anton Sidawy  1 , Bao-Ngoc Nguyen  1
Affiliations
Case Reports

Preservation of renal perfusion by hepatorenal and splenorenal bypasses before explantation of an infected abdominal aortic endograft

Brandon Neil Glousman et al. J Vasc Surg Cases Innov Tech. .

Abstract

We report the case of an 82-year-old patient with an infected abdominal aortic endograft who presented with a right psoas abscess and lumbar osteomyelitis. The psoas abscess was drained percutaneously. Fluid obtained grew Fusobacterium nucleatum. The patient, an active and highly functional individual, wished to pursue definitive management. The infected endograft was surgically removed, and the aorta was ligated above the renal arteries after staged axillary-bifemoral, hepatorenal, and splenorenal bypasses.

Keywords: Abdominal aortic endograft infection; Aortic ligation; Axillobifemoral bypass; Hepatorenal bypass; Splenorenal bypass.

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Figures

Fig 1
Fig 1
Magnetic resonance imaging demonstrating the right psoas abscess (arrow), which is contiguous with the severely inflamed aneurysm sac surrounding the endograft.
Fig 2
Fig 2
Enhancement of the endograft and aneurysm sac on positron emission tomography-computed tomography scan confirmed the clinical suspicion of an endograft infection.
Fig 3
Fig 3
The pararenal (A) and juxtarenal (B) aortic tissues were severely inflamed (arrow), but the aortic wall below the superior mesenteric artery (SMA) was normal (C).
Fig 4
Fig 4
The patient's final anatomy after the removal of the infected endograft (A). The two Amplatzer plugs are shown in the right external and internal iliac arteries. The perfusion to the pelvis is maintained by the left hypogastric artery. The abdominal aorta is ligated just below the superior mesenteric artery (SMA; B). Both kidneys are well perfused by the hepatorenal and splenorenal bypasses (B).
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