Repair of Mycotic Paravisceral Aneurysm with a Fenestrated Stent-Graft

PURPOSE: To report the successful endovascular repair of a mycotic paravisceral aneurysm using a fenestrated stent-graft. METHODS AND RESULTS: A 55-year-old white female with a history of rheumatoid arthritis presented with an 8-cm paravisceral aneurysm secondary to pneumonia complicated by empyema. Intravascular ultrasound identified a defect in the aortic wall at the level of the celiac axis. Repair was accomplished with a fenestrated stent-graft that excluded the aneurysm and maintained flow to the celiac axis and superior mesenteric artery. Recovery was uneventful and the patient was discharged in 2 days. Six-month follow-up computed tomographic scanning confirmed aneurysm exclusion and flow to the celiac and superior mesenteric arteries. There was no evidence of graft infection. The patient died from a clinically diagnosed myocardial infarction 10 months after the stent-graft repair. CONCLUSIONS: Fenestrated stent-graft repair may evolve into a useful technique for the treatment of mycotic paravisceral aneurysms.