Open Repair of Aortic Arch Mycotic Pseudoaneurysms With Distal Perfusion.

ABSTRACT An 80-year-old man presented with a fast expanding 9.5 cm mycotic arch pseudoaneurysm. The right axillary and femoral arteries were cannulated. Through sternotomy, A reverse zone 2 arch replacement was performed with a 28-mm rifampin-soaked Dacron graft with circulatory arrest. A 30-millimeter Coda balloon was used to occlude the descending aorta and the lower body was perfused through the femoral artery. The infected pseudoaneurysm was debrided and irrigated. A separate 28-mm rifampin-soaked Dacron was anastomosed to the proximal-descending aorta. The left subclavian artery was anastomosed to the proximal Dacron graft. Finally, the proximal and distal Dacron grafts were anastomosed together.