Neo-Aortoiliac reconstruction of complicated aneurysms: First case report in a Peruvian hospital

Helen Sofía Choquehuanca-Bedoya; Jarol Isaac Núñez-Barrientos; Mónica Danae Pérez-Cuello; Martín Augusto Gil-Cusirramos; Neyel Abner Cáceres-Cancho; Daniel  Silva-Naupari

doi:10.47487/apcyccv.v7i2.608

Authors

Helen Sofía Choquehuanca-Bedoya Vascular Surgery Unit, Hospital Nacional Guillermo Almenara, Lima, Peru; Thoracic and Cardiovascular Surgery, Universidad Nacional Mayor de San Marcos, Lima, Peru. https://orcid.org/0009-0007-2797-0065
Jarol Isaac Núñez-Barrientos Vascular Surgery Unit, Hospital Nacional Guillermo Almenara, Lima, Peru. https://orcid.org/0000-0002-2611-2444
Mónica Danae Pérez-Cuello Vascular Surgery Unit, Hospital Nacional Guillermo Almenara, Lima, Peru; Thoracic and Cardiovascular Surgery, Universidad Nacional Mayor de San Marcos, Lima, Peru. https://orcid.org/0009-0001-4479-8822
Martín Augusto Gil-Cusirramos Vascular Surgery Unit, Hospital Nacional Guillermo Almenara, Lima, Peru. https://orcid.org/0000-0002-1884-4987
Neyel Abner Cáceres-Cancho Vascular Surgery Unit, Hospital Nacional Guillermo Almenara, Lima, Peru. https://orcid.org/0009-0002-9505-7458
Daniel Silva-Naupari Vascular Surgery Unit, Hospital Nacional Guillermo Almenara, Lima, Peru.

DOI:

https://doi.org/10.47487/apcyccv.v7i2.608

Keywords:

Aorta, Mycotic Aneurysm, Femoral Vein, Vascular Surgical Procedures

Abstract

Mycotic aneurysms are rare vascular pathologies requiring tailored surgical approaches in septic and anatomically complex settings. We present the case of a 68-year-old male with diabetes mellitus and tobacco use, admitted with abdominal sepsis and purulent perianal discharge. Imaging revealed a ruptured 90 mm infrarenal abdominal aortic aneurysm with features suggestive of an aortomesenteric fistula. Due to the high risk of prosthetic graft infection, aortic reconstruction with an autologous femoral vein was selected. After preoperative venous mapping, a bifurcated graft was constructed using a reversed femoral vein following the Neo-aortoiliac system principles and the Myller cuff technique. During laparotomy, the contained ruptured aneurysm with multiple adhesions was confirmed, and the autologous graft was interposed proximally at the aorta and distally at the iliac arteries. This case highlights the feasibility of autologous vein grafting in complex infected aortic reconstruction within a septic setting.

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References

Somers T, Nies HMJM, Kouijzer IJE, Lee PY, Morshuis WJ, Geuzebroek GSC. Mycotic aortic aneurysms: characteristic macroscopic findings in a case series. Scand Cardiovasc J. 2024;58(1):2341696. doi: 10.1080/14017431.2024.2341696.

Perez Burkhardt JL. Aneurismas micóticos: particularidades diagnósticas y de tratamiento. Angiologia. 2015;68(1):46-54. doi: 10.1016/j.angio.2015.06.003.

Ghaly P, Di Mascio D, Vicaretti M. Infrarenal aortic reconstruction using autologous femoral vein for a mycotic aneurysm caused by Streptococcus equi. J Surg Case Rep. 2021;2021(9):rjab388. doi: 10.1093/jscr/rjab388.

Sörelius K, Budtz-Lilly J, Mani K, Wanhainen A. Systematic Review of the Management of Mycotic Aortic Aneurysms. Eur J Vasc Endovasc Surg. 2019;58(3):426-435. doi: 10.1016/j.ejvs.2019.05.004.

Eidt JF, Gucwa AL, Ali A. How I do it: The neoaortoiliac system for treatment of aortoduodenal fistula after endovascular aortic repair. J Vasc Surg Cases Innov Tech. 2022;8(4):830-839. doi: 10.1016/j. jvscit.2022.11.001.

Shao CC, McFarland GE, Beck AW. Emergent repair of infected aortic aneurysm with contained rupture using a femoral vein neoaortoiliac system. J Vasc Surg Cases Innov Tech. 2021;7(3):502-505. doi: 10.1016/j.jvscit.2021.06.003.

Chakfé N, Diener H, Lejay A, Assadian O, Berard X, Caillon J, et al. Editor’s Choice - European Society for Vascular Surgery (ESVS) 2020 Clinical Practice Guidelines on the Management of Vascular Graft and Endograft Infections. Eur J Vasc Endovasc Surg. 2020;59(3):339-384. doi: 10.1016/j.ejvs.2019.10.016.

Wu JW, Zhang Y, Chen SR, Seeruttun SR, Ke CL, Hu WX, et al. Aortoenteric fistula: clinical features, diagnostic challenges, and surgical outcomes - a retrospective analysis of 10 cases. BMC Gastroenterol. 2025;26(1):38. doi: 10.1186/s12876-025-04539-x.

Ghista DN, Kabinejadian F. Coronary artery bypass grafting hemodynamics and anastomosis design: a biomedical engineering review. Biomed Eng Online. 2013;12:129. doi: 10.1186/1475-925X-12-129.

Krzyzaniak H, Vergouwen M, Xuan-Zeng R, Rockley M, Rommens K, Moore RD. Long-term outcomes of neoaortoiliac system for treatment of aortic graft infection. JVS Vasc Insights. 2025;3:100194. doi: 10.1016/j.jvsvi.2025.100194.

Lyons OT, Patel AS, Saha P, Clough RE, Price N, Taylor PR. A 14-year experience with aortic endograft infection: management and results. Eur J Vasc Endovasc Surg. 2013;46(3):306-13. doi: 10.1016/j. ejvs.2013.04.021.