Prosthetic graft infection involving the thoracic aorta: graft excision and extra-anatomic revascularization.

Late-appearing infection of prosthetic grafts continues to plague the vascular surgeon. Although generally caused by biofilm-producing coagulase-negative staphylococci, other Gram-positive, as well as Gram-negative, organisms may also be etiologic. Extra-anatomic revascularization with either simultaneous or staged removal of the entire contaminated prosthesis has emerged as the preferred method of management of the infected aortic prosthesis. In addition to the usual technical problems accompanying surgery for aortic graft infection, operation for prosthetic graft infection involving the ascending aorta and aortic arch introduces the potential problem of temporary cerebral ischemia. The successful management of a 64-year-old woman with late Staphylococcus aureus infection of an aortoinnominate-left subclavian bifurcation graft by graft excision and extra-anatomic revascularization, in whom intraoperative cerebral ischemia was circumvented by initial placement of a right femoroaxillary bypass graft is described here.