RESUMO
A 62-year-old woman, who received implantation of a prosthetic graft for treatment of a descending aortic aneurysm 15 months previously, was admitted with hemoptysis. An aortogram demonstrated communication from the distal anastomosis to S<sup>6</sup> of the left lung. After removal of the aorta across the distal anastomosis concomitantly with left lower lobectomy, we replaced a short segment of the graft. Culture of the pus obtained from the anastomotic site was positive for MRSA. Postoperatively, although the left pleural cavity was irrigated continuously with 1% popidone iodine solution, massive bleeding from the distal anastomosis appeared again 2 weeks later. This time, to remove the infected graft as much as possible, two extraanatomical bypasses were created between the right axillary and right femoral arteries, and the ascending and abdominal aorta. The closed prosthetic and aortic stumps were covered by a viable omental flap. Four months later, bleeding occurred again at the site of the proximal anastomosis. The last radical surgery was performed extrapleurally through a trapdoor thoractomy made in the left infraclavicular region. There was a 1.5cm long laceration of the aorta just proximal to the oldest graft-aortic anastomosis. The aorta was divided and closed between the left common carotid and subclavian arteries. The left subclavian artery was ligated at its origin. The pleural cavity was continuously irrigated with popidone iodine to clean up the microorganisms. She was discharged from the hospital on the 258 POD and has been doing well since then.