Off-Pump Explantation of an Infected Thoracic Branched Endograft With Aortic Arch Exclusion.

BACKGROUND: Endograft infection is a rare but devastating complication of thoracic endovascular aortic repair (TEVAR), traditionally managed with cardiopulmonary bypass and circulatory arrest. CASE SUMMARY: A 57-year-old man developed sepsis and hemoptysis 2 months after branched TEVAR for traumatic arch pseudoaneurysm. Imaging revealed perigraft infection with gas and extension into the lung. Given prohibitive risks of conventional bypass, an off-pump ascending-to-descending bypass with sequential supra-aortic debranching was performed via median sternotomy, enabling complete arch exclusion and explantation of the endograft. The patient recovered and remained well at 1-year follow-up. DISCUSSION: This case demonstrates the feasibility of off-pump infected TEVAR explantation in critically ill patients, avoiding hypothermic circulatory arrest while achieving durable infection source control. TAKE-HOME MESSAGE: Off-pump explantation of an infected branched TEVAR with complete arch exclusion may provide a life-saving alternative when conventional bypass strategies are considered prohibitive.