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High operative mortality of infected thoracoabdominal aortic aneurysms (ITAA) is partly attributable toischemic injury during aortic clamping. We report a 62-year-old man with biliary cirrhosis, who developed a rapidlyenlarging ITAA secondary to thoracolumbar osteomyelitis. Additional infectious foci were found in the pubic and ischialbones and in the left lung. Blood cultures gave growth of streptococcus pneumoniae. The aneurysm was repaired througha thoracoabdominal incision with a Dacron prosthesis. Prior to aneurysm repair, a prosthetic shunt was anastomosed end –to- side to the aortic prosthesis and to the descending aorta using a side-biting clamp. The shunt allowed perfusion of thelower body and of renal and visceral vessels after 45 minutes, the time needed to resect infected tissue and complete thedistal anastomosis. The proximal anastomosis and orthopedic treatment of the spinal osteomyelitis could be performed,while the lower body and visceral organs were perfused.Postoperatively, the patient developed hypotension and increasing lactacidosis. Laparotomy revealed intestinal infarction,and gut resection was performed. Following a temporary improvement, he developed multiorgan failure and candidasepsis and died after 32 days. No atheroemboli were found in arteries of resected intestines. Portal hypertension mostlikely was present and it could be calculated that minimum intestinal perfusion pressure the night after the operation couldhave been in the range of 30-37 mm Hg, which probably was not enough to maintain aerobic metabolism. In the presenceof aortic atheromas it may be advisable to divert blood to the shunt from an axillary artery

the open cardiovascular and thoracic surgery journal

Temporary Prosthetic Shunt to Permanent Aortic Prosthesis in a Patient with an Infected Thoracoabdominal Aneurysm to Shorten Ischemia Time~!2010-04-04~!2010-06-03~!2010-07-26~!