Surgical considerations of infection following operations involving the descending thoracic aorta

Infection in the region of aortic repair is a dreaded complication and is well known to occur after abdominal aortic operations when prosthetic grafts communicate with groin incisions. Although the incidence of this complication is now less than 1% in these cases, it has varied from 1.3% to 6.0% and is associated with a mortality rate varying between 25% and 75%. Principles of treatment in such cases include appropriate antibiotic therapy, removal of infected prosthetic grafts, and restoration of distal circulation when necessary to avoid peripheral ischemia. The latter has been necessary in over 50% of cases and has been accomplished (a) rarely by insertion of a new graft, (b) by local reconstruction using autogenous tissue, and (c) more commonly by closing the involved aortic and arterial openings and performing an extra-anatomic bypass. Although little has been written about this problem occurring after operations for lesions of the descending thoracic aorta, such problems are known to occur. This report is concerned with a detailed review of the 9 reported cases treated surgically and 2 cases that the authors treated. Analysis of this material indicates that the principles learned from treating infected operative sites in the abdominal aorta apply to similar lesions occurring in the descending thoracic aorta.