Successful Management of a Periaortic Graft Abscess After DeBakey Type I Aortic Dissection Repair: A Case Report

Background Periaortic and aortic graft infections (AGI) following thoracic aortic reconstruction are uncommon complications with reported mortality of 25–75% and limited standardised treatment guidance, with debate between graft preservation and complete explantation. Case presentation A 61-year-old man with type 2 diabetes and obesity (body mass index 41 kg/m²) underwent supracoronary ascending aorta and complete aortic arch replacement for DeBakey type I (Stanford A) acute aortic dissection. Five months postoperatively, recurrent high-grade fever and Pseudomonas aeruginosa bacteraemia developed despite carbapenem therapy. Contrast-enhanced CT demonstrated a progressive perigraft infiltrative collection contiguous with both prosthetic grafts. Redo sternotomy was performed with abscess evacuation and complete replacement of both ascending and arch grafts; intraoperative cultures again grew P. aeruginosa. The patient was discharged on day 30 with culture-directed lifelong ciprofloxacin; follow-up CT confirmed clearance. Discussion The case fulfilled two MAGIC major criteria (radiologic and microbiologic) and one minor (clinical), confirming AGI. Decisions between graft preservation and complete explantation depend on infection chronology and pathogen virulence; for early-onset deep mediastinal involvement with virulent gram-negative pathogens, complete graft excision combined with prolonged culture-directed antibiotic therapy was the most reliable strategy in this patient. Conclusion Successful management of periaortic graft abscess after thoracic aortic reconstruction requires high clinical suspicion, MAGIC-criteria-anchored diagnosis, complete graft explantation when infection is established, culture-directed antibiotic therapy, and structured long-term surveillance. Keywords aortic graft infection; periaortic abscess; aortic dissection; DeBakey type I; Pseudomonas aeruginosa; redo cardiac surgery; mediastinitis; MAGIC criteria