Outcomes Following Different Management of Mycotic Infrarenal Abdominal Aortic Aneurysms.

OBJECTIVE: The objective was to present our experience on managing mycotic infrarenal abdominal aortic aneurysm (MIAAA) through a retrospective cohort study. METHODS: Data of patients with MIAAA managed in our center from July 2016 to October 2022 were retrospectively analyzed. The diagnosis of MIAAA was made based on: (1) preoperative clinical signs of infection; (2) elevated serologic infection parameters; (3) para-aneurysmal infection features on enhanced computed tomography; and (4) positive blood or tissue cultures. All the patients received standard antibiotic therapy. Surgical management including endovascular aneurysm repair (EVAR), initial EVAR followed by open re-operation, and initial open surgical repair (OSR) were conducted according to disease seriosity, physical condition, and patient's will. Infection index and clinical outcome were evaluated during the follow-up time. RESULTS: A total of 23 patients (21 men; averaged=66.3 years, range=49-79 years) were included, with a mean follow-up time of 19.9 months (range=1-75 months). Bacteria culture from blood or tissue specimen was positive in 15 patients (Salmonella, n=8; Escherichia coli, n=3; methicillin-sensitive Staphylococcus aureus [MSSA], n=1; Klebsiella pneumoniae, n=1; Staphylococcus epidermidis, n=1; Mycobacterium tuberculosis, n=1). Seven patients received OSR as the initial surgical intervention, whereas 14 patients chose EVAR instead. The 2 conservatively managed patients (refused surgery) died within 30 days. The 7 patients who received initial OSR survived till now. Among the 14 patients who underwent initial EVAR, infection deteriorated without exception (14/14, 100%). Three of these patients refused re-operation and died within 6 months. Eleven patients received secondary surgical intervention (10 cases of aneurysm and endograft resection, thorough debridement, subclavian to bi-femoral artery bypass, or in situ aorta reconstruction; 1 case of laparoscopic debridement) and 7 survived the follow-up time. The overall mortality rate was 39.1% (9/23). The mortality rates differed greatly following different intervention methods (merely antibiotic management, 100%; initial open operation, 0%; initial EVAR without secondary operation, 100%; initial EVAR plus secondary operation, 36.4%). CONCLUSIONS: Open surgical repair is still the first choice for hemodynamically stable and low-risk patients. Merely EVAR is related with disastrous results, which should be reserved as a temporary alternative for patients with ruptured aneurysms, hemodynamic instability or high surgical risk, and followed by timely secondary OSR. CLINICAL IMPACT: The management of mycotic or primary-infected aortic aneurysm is challenging; treatment remains controversial. Our center has reviewed our experience over the past 6 years and found that open surgical repair is still the first choice for hemodynamically stable and low-risk patients. Merely endovascular aneurysm repair (EVAR) is related with disastrous results, which should be reserved as a temporary alternative for patients with ruptured aneurysms, hemodynamic instability or high surgical risk, and followed by timely secondary open surgical repair.

Assessment of the Effectiveness of Zone 1-Landing Hybrid TEVAR by Comparing Its Outcomes with Those of Zone 2-Landing Hybrid TEVAR.

Background: Hybrid thoracic endovascular aortic repair (TEVAR) without median sternotomy is increasingly being performed in high-risk patients with aortic arch disease. The outcomes of hybrid TEVAR were reported to be worse with a more proximal landing zone. This study aims to clarify the effectiveness of zone 1-landing hybrid TEVAR by comparing the outcomes of zone 2-landing hybrid TEVAR. Methods: From April 2008 to October 2020, 213 patients (zone 1: zone 1-landing hybrid TEVAR, n = 82, 38.5%; zone 2: zone 2-landing hybrid TEVAR, n = 131, 61.5%) were enrolled (median age, 72 years; interquartile range [IQR], 65-78 years), with a median follow-up period of 6.0 years (IQR, 2.8-9.7 years). Results: The mean logistic EuroSCORE was 20.9 ± 14.8%: the logistic EuroSCORE of the zone 1 group (23.3 ± 16.1) was significantly higher than that of the zone 2 group (19.3 ± 12.4%, p = 0.045). The operative time and hospital stay of the zone 1 group were significantly longer than those of the zone 2 group. On the other hand, the in-hospital and late outcomes did not differ significantly between the two groups. There were no significant differences in cumulative survival (66.8% vs. 78.0% at 10 years, Log-rank p = 0.074), aorta-related death-free rates (97.6% vs. 99.2% at 10 years, Log-rank p = 0.312), and aortic event-free rates (81.4% vs. 87.9% at 10 years, Log-rank p = 0.257). Conclusions: Zone 1- and 2-landing hybrid TEVAR outcomes were satisfactory. Despite the high procedural difficulty and surgical risk, the outcomes of zone 1-landing hybrid TEVAR were equal to those of zone 2-landing hybrid TEVAR. If the surgical risk is high, zone 1-landing hybrid TEVAR should not be avoided.

Extra-anatomical Obturator Bypass Due to Groin Infection.

Background: A rather common side effect of using prosthetic grafts is infection of the groin area. Infections in the groin may be avoided by performing arterial bypass tenneling via the obturator foramen during lower extremity revascularization. This study aimed to evaluate the safety and efficacy of extra-anatomical bypass obturator in patients with groin infection. Methods: This cohort included a convenient sample of 100 patients with groin infections who planned to do an extra-anatomical obturator bypass. All patients were subjected to history taking and clinical assessment. Ultrasonography with duplex screening is a good initial technique to assess groin masses. Combination of computed tomography (CT) or magnetic resonance imaging (MRI) with indium-labeled leucocyte scintigraphy can also play a role in the diagnosis. Results: Inflow from the already-existing graft limb was used in 54% of obturator canal bypass (OCB) procedures, with 32 limbs coming from the main iliac (27.3%) and 6 limbs from the infrarenal aorta (5.1%). The distal superficial femoral artery was used in 21 limbs (17.9%), while the above-knee popliteal artery was selected as the outflow artery in 82% of cases. Primary aided patency was 68% at 24 months, according to Kaplan-Meier analysis, whereas primary patency was 63% at that time. At 24 months, the secondary patency of the OCB was 83%. Conclusion: In case of groin infections, an excellent option to restore flow is an obturator bypass graft. This graft is strong, reliable, and safe. As a result of its high patency rate, it may be the first choice in certain circumstances.

Open after endovascular repair for previous extra anatomic bypass of adult coarctation.

BACKGROUND: During follow-up, aneurysm formation in adults with coarctation of aorta has been reported after undergoing extra-anatomical aortic bypass grafting. Endovascular repair was a reasonable treatment option but there were still complications. CASE PRESENTATION: A 48-year-old male who underwent extra-anatomical aortic bypass grafting, presented with severe back pain and hemoptysis. He had a diagnosed pseudoaneurysm with concealed rupture at the bypass grafting. He underwent endovascular repair and coil embolization. A postsurgical CT-angiogram showed there was extravasation from stent into the pseudoaneurysm. An open repair with endovascular stent removal instead of restenting was performed.

Transaxillary Tri-Branch Aortic Endovascular Graft Repair of Recurrent Thoracoabdominal Aneurysm With Pararenal Aortic Occlusion.

The absence of an adequate ileo-femoral access is usually considered an absolute contraindication to fenestrated and branched aortic repairs. Alternative routes and dedicated stent-graft designs have been advocated. Hereby, we describe the case of a 73-year-old man with a recurrent type IV thoracoabdominal aortic aneurysm and complete thrombotic pararenal aortic occlusion treated successfully with a tri-branch custom-made endograft deployed via a transaxillary access.

Stent-Graft Infection with Severe Pulmonary Adhesion Cured by Extra-Anatomical Bypass through the Anterior Position of the Pulmonary Hilum: a Case Report / 日本心臓血管外科学会雑誌

This is a case of an 81-year-old male who underwent stent-graft (SG) placement for type B aortic dissection at the age of 79. Two and a half years after the surgery, he was diagnosed with SG infection. Although he was scheduled for SG removal and the in-situ replacement of the descending aorta, he had difficulty maintaining oxygenation under single lung ventilation and detaching the severe adhesion of the aneurysm to the lung; therefore, only the aneurysm sac was opened, and abscess drainage was performed. The continuous irrigation and drainage of the aneurysm sac were performed, but the infection did not improve. On the 6th day after the surgery, the aortic aneurysm in the lung adhesion area was left untreated, and an extra-anatomical bypass was performed from the distal aortic arch to the anterior position of the pulmonary hilum, anastomosing with the abdominal aorta. All SGs were removed, the abscess and intima of the aortic aneurysm were extensively excised, and the remaining cavity was filled with omentum. The infection rapidly improved after the surgery, and he was discharged on the 52nd day after admission. Fortunately, the infection did not recur for 2 years since the surgery. This procedure is useful as an option for surgical reconstruction for stent graft infection for which in-situ descending aorta replacement is difficult.

Stent-Graft Removal and Extra-Anatomical Bypass for the Treatment of Stent-Graft Infection after Endovascular Aneurysm Repair.

Stent-graft infection is a rare but potentially life-threatening complication of endovascular aortic repair. There are currently no consensus guidelines for treating stent-graft infections, but surgical treatment is generally considered preferable due to the low overall survival rate of patients receiving conservative therapy; however, the revascularization method remains controversial. We report a case in which stent-graft infection after endovascular aneurysm repair was successfully treated by stent-graft removal and extra-anatomical bypass (EAB). EAB is an effective method of revascularization for stent-graft infection.

Surgical 5-year Outcomes of Extra-Anatomical Bypass for Middle Aortic Syndrome: A Case Series.

BACKGROUND: Middle aortic syndrome is a rare disease. Several surgical treatments are available; however, the optimal treatment strategy and long-term outcomes remain unelucidated. We herein report the 5-year outcomes of six patients treated with extra-anatomical bypass surgery for middle aortic syndrome. CASE PRESENTATIONS: Between 2013 and 2016, six patients underwent extra-anatomical bypass for middle aortic syndrome at our institute: three had Takayasu's arteritis, one had vessel vasculitis, and two had middle aortic hypoplastic syndrome of unknown origin. The patients included five women and one man, with a mean age of 59.7 years. Four patients had uncontrolled hypertension and were receiving antihypertensive medications. The mean ankle-brachial pressure index was .61. The three patients with Takayasu's arteritis were hospitalized for congestive heart failure. These patients underwent bypass surgery from the descending aorta to the infrarenal abdominal aorta, and one also underwent concomitant heart surgery. The patient with microscopic polyangiitis underwent Y-grafting with an aortic aneurysmectomy. Subsequently, bypass surgery was performed from the descending aorta to the graft via the diaphragm. The two patients with unknown causes underwent bypass surgery from the proximal descending aorta to the distal descending thoracic aorta. There were no early or late deaths at the 5-year follow-up. We did not observe any changes in anastomotic site stenosis or new aneurysmal changes during the follow-up period. The number of antihypertensive medications was reduced in all cases, and critical symptoms, including headache, severe abdominal pain, claudication, and heart failure, improved in all patients. The ankle-brachial pressure index increased to 1.11 and did not change for five years. Renal function remained stable, and the brain natriuretic peptide level decreased from 302.8 to 74.5 pg/mL at follow-up. CONCLUSION: Extra-anatomical bypass for middle aortic syndrome is safe and effective, and can help prevent renal failure, and relieve critical ischemic symptoms.

Successful surgical treatment of the supradiaphragmatic middle aortic syndrome by an extra-anatomical bypass in a child.

We report a 5-year-old girl (13kg) was referred to our facility for cardiologic examination due to uncontrolled hypertension and significant heart failure. Chest radiography elevated cardiothoracic ratio of over 60% with rib notching and the absence of an aortic knob. Transthoracic echocardiography showed a dilated left ventricle with a reduced ejection fraction and significant stenosis of the descending aorta with a pressure gradient of 64 mm Hg. Computed tomography angiography confirmed the type of supradiaphragmatic middle aortic syndrome, with severe stenosis segment 75 mm of the descending aorta was visible around 20 mm above the diaphragm. The narrowest point was estimated to be 1.85 mm. In addition, the ascending aorta, aortic arch, and supra-cervical branches were all normal, as were the abdominal aorta and its major branches. Our patient underwent surgery, a 9.0 mm Dacron bypass was performed between the ascending and the terminal descending thoracic aorta. Extra-anatomical ascending-to-descending aortic bypass is a relatively safe and successful therapy option for supradiaphragmatic middle aortic syndrome.

Editor's Choice - Outcome of Radical Surgical Treatment of Abdominal Aortic Graft and Endograft Infections Comparing Extra-anatomic Bypass with In Situ Reconstruction: A Nationwide Multicentre Study.

OBJECTIVE: Abdominal aortic graft and endograft infection (AGI) is primarily treated by resection of the infected graft and restoration of distal perfusion through extra-anatomic bypass (EAB) or in situ reconstruction/repair (ISR). The aim of this study was to compare these surgical strategies in a nationwide multicentre retrospective cohort study. METHODS: The Swedish Vascular Registry (Swedvasc) was used to identify surgically treated abdominal AGIs in Sweden between January 1995 and May 2017. The primary aim was to compare short and long term survival, as well as complications for EAB and ISR. RESULTS: Some 126 radically surgically treated AGI patients were identified - 102 graft infections and 24 endograft infections - treated by EAB: 71 and ISR: 55 (23 neo-aorto-iliac systems, NAISs). No differences in early 30 day (EAB 81.7% vs. ISR 76.4%, p = .46), or long term five year survival (48.2% vs. 49.9%, p = .87) were identified. There was no survival difference comparing NAIS to other ISR strategies. The frequency of recurrent graft infection during follow up was similar: EAB 20.3% vs. ISR 17.0% (p = .56). Survival and re-infection rates of the new conduit did not differ between NAIS and other ISR strategies. Age ≥ 75 years (odds ratio [OR] 4.0, confidence interval [CI] 1.1 - 14.8), coronary artery disease (OR 4.2, CI 1.2 - 15.1) and post-operative circulatory complications (OR 5.2, CI 1.2 - 22.5) were associated with early death. Prolonged antimicrobial therapy (> 3 months) was associated with reduced long term mortality (HR 0.3, CI 0.1 - 0.9). CONCLUSION: In this nationwide multicentre study comparing outcomes of radically treated AGI, no differences in survival or re-infection rate could be identified comparing EAB and ISR.

Extra-Anatomical Bypass Grafting and Latissimus Dorsi Myocutaneous Flap Reconstruction for Post-sternotomy Mediastinitis With Prosthetic Aortic Graft Infection.

Extra-anatomical bypass grafting is a surgical method used to remove an infected aortic graft and promote revascularization with a new graft in the non-infected area. Here, we report a case of intractable post-sternotomy mediastinitis (PSM) with aortic graft infection which was treated with extra-anatomical bypass grafting. A 56-year-old woman with a history of multiple aortic dissection and prosthetic graft replacement in the thoracoabdominal area developed PSM with aortic arch graft infection. Bacterial culture of the exposed prosthetic graft tissue yielded multidrug-resistant Pseudomonas aeruginosa. Meticulous debridement of the wound and management by negative pressure wound therapy with continuous irrigation was performed. However, the infection of the prosthetic graft could not be controlled. Extra-anatomical bypass was performed between the left common carotid artery and right subclavian artery via the right common carotid artery. Then, the infected graft was removed. After the resolution of infection, the mediastinal wound was reconstructed with a pedicled latissimus dorsi myocutaneous flap, which was harvested from the right dorsum. No recurrence of infection occurred in the nine-month follow-up period. Debridement and removal of exposed artificial graft are considered the gold standard for treating wound infection. In situ replacement of infected aortic grafts carries a risk of re-infection due to residual bacterial contamination of the periprosthetic tissue. Extra-anatomical bypass would be a useful option for reducing the risk of re-infection in patients with intractable PSM and prosthetic aortic graft infection. Further studies are warranted to evaluate the risks and benefits of this operative method.

Hybrid Approach to Complex Stanford Type B Dissection: Unusual Extra-anatomical Bypass (Aorto-Celiac-Mesenteric Bypass) + Thoracic Endovascular Aortic Repair (TEVAR) + Cholecystectomy

Abstract Patients with complex Stanford type B aortic dissection are very difficult to treat. Many methods have been proposed so far in the treatment of these patients, and the emergence of hybrid techniques has made the treatment easier. In this article, we shared the extra-anatomical bypass (aorto-celiac-mesenteric bypass) + thoracic endovascular aortic repair + cholecystectomy operation technique applied to a patient with complex type B aortic dissection.

Descending aortic transection for recurrence of a pseudoaneurysm previously treated with a stent graft after extra-anatomical bypass for aortic coarctation: a case report.

BACKGROUND: In adult patients with primary or recurrent coarctation of the aorta (CoA), extra-anatomic bypass grafting (EABG) has been widely used as a surgical treatment option. However, there have been few reports on pseudoaneurysms (PAs) of the distal anastomotic sites after extra-anatomic bypass for CoA. CASE PRESENTATION: A 51-year-old man with hemoptysis was transferred to our hospital. Twenty years ago, he had undergone EABG from the ascending to the descending aorta (ascending-to-descending EABG) for CoA with right aortic arch. Eight years ago, he underwent thoracic endovascular aortic repair (TEVAR) for the ruptured PA on the distal anastomotic site of the EABG. Contrast-enhanced computed tomography scans revealed recurrent ruptured PA on the distal anastomotic site of the EABG. Therefore, we decided to replace the descending aorta, followed by end-to-side anastomosis of the EABG to the replaced descending aorta. However, due to massive adhesion of the lung to the EABG and PA, we performed transection of the descending aorta to decompress the PA. The postoperative course was uneventful, and the patient is doing well 5 months after surgery. CONCLUSIONS: Aortic transection between the CoA and the distal anastomosis site may be a useful additional procedure in patients previously treated with TEVAR for PAs in the distal anastomosis site after EABG.

Hybrid Approach to Complex Stanford Type B Dissection: Unusual Extra-anatomical Bypass (Aorto- Celiac-Mesenteric Bypass) + Thoracic Endovascular Aortic Repair (TEVAR) + Cholecystectomy.

Patients with complex Stanford type B aortic dissection are very difficult to treat. Many methods have been proposed so far in the treatment of these patients, and the emergence of hybrid techniques has made the treatment easier. In this article, we shared the extra-anatomical bypass (aorto-celiac-mesenteric bypass) + thoracic endovascular aortic repair + cholecystectomy operation technique applied to a patient with complex type B aortic dissection.

[Surgical treatment of a patient with traumatic rupture of the aortic arch and late oesophageal perforation]. / Khirurgicheskoe lechenie bol'nogo s travmaticheskim razryvom dugi aorty i pozdnei perforatsiei pishchevoda.

Described herein is a clinical case report regarding a patient presenting with traumatic rupture of the aortic isthmus with the development of a pseudoaneurysm occupying virtually the entire posterior mediastinum and measuring 20?10 cm in size. He was immediately treated as an emergency to undergo prosthetic reconstruction of the portion of the aortic arch and descending thoracic aorta by means of temporary bypass grafting with a synthetic graft in order to protect the visceral organs. The postoperative period was complicated by oesophageal perforation with the formation of an oesophago-paraprosthetic fistula, infection of the vascular graft, accompanied by the development of pleural empyema and mediastinitis. A second operative procedure was performed, consisting of subclavian-iliac bypass grafting on the right with a polytetrafluoroethylene graft measuring 20 mm in diameter, exclusion of the intrathoracic portion of the oesophagus, creation of a gastro- and oesophagostoma, retrieval of the vascular graft followed by suturing of the aorta, pleurectomy, decortication of the lung, and removal of the empyemic sac on the left. There was no evidence of ischaemia of the spinal cord or visceral arteries. One month postoperatively, he underwent a traumatological stage and 4 months thereafter plasty of the oesophagus with an isoperistaltic gastric pedicle, extirpation of the thoracic portion of the oesophagus, to be later on followed by closure of the oesophagostoma. The patient experienced no difficulties either while walking or during other physical activities, with the ankle-brachial index amounting to 0.9. With time, he developed difficult-to-correct pulmonary hypertension. Unfortunately, the patient eventually died of acute cardiopulmonary insufficiency 9 years after right-sided extra-anatomical subclavian-iliac bypass grafting.

[Bypass grafting in patients with infected vascular grafts]. / Obkhodnoe shuntirovanie pri infitsirovanii sosudistogo proteza.

Analysed herein are the results of treating a total of 17 patients presenting with pathology of the aorta and lower-limb arteries, who from 2010 to 2018 required redo interventions due to infection of a previously implanted synthetic vascular graft. At admission, 3 patients were diagnosed as having an open infected wound, 11 were found to have a fistula, 2 had a false aneurysm in the area of the distal anastomosis of the branch of the bifurcation aortofemoral prosthesis, and 1 had thrombosis of the branch of the prosthesis with evidence of infection. As redo surgery, 4 patients underwent subclavian-femoral bypass grafting, 2 were subjected to crossover iliac-femoral bypass grafting, 8 to unilateral iliac-femoral bypass grafting, 3 to loop endarterectomy. In the majority of cases (14 of the 17) we used bypass grafting with creation of the tunnel through the muscular lacuna. Lethal outcomes were registered in 35% (n=6) of cases in the early postoperative period. Death was caused by acute renal failure in 6% (n=1), by acute mesenteric thrombosis in 12% (n=2), by gastrointestinal haemorrhage in 6% (n=1), and by multiple organ failure in 12% (n=2). Long-term mortality amounted to 33% (n=3) within 12 months. The main causes of death were increasing renal failure in 10% (n=1) and cardiovascular insufficiency on the background of heart diseases in 10% (n=1), as well as respiratory insufficiency in 10% (n=1). Reinfection in the remote period was diagnosed in 1 patient. A conclusion was drawn that bypass grafting is traumatic, however, it may be the only way to save the limb or patient's life in a complicated clinical situation. Using the superficial femoral vein as a shunt demonstrated good long-term results as to patency and resistance to surgical infection. Using a flap of the greater omentum, retroperitoneal fat, as well as wrapping of the prosthesis with a muscular flap ensured good tolerance of the zone of bypass grafting to reinfection.

Branched Endovascular Aortic Plug in Patients With Infrarenal Aortic Graft Infection and Hostile Anatomy.

Purpose: To present a novel 4-branched endovascular aortic plug (BEVAP) for treatment of patients with infrarenal aortic graft infection. Case Reports: Two polymorbid male patients with aortic graft infections and an unsuturable diseased paravisceral aorta were treated under compassionate use with a custom-made stent-graft. The BEVAP is a factory-modified Zenith t-Branch thoracoabdominal endovascular graft with the distal tubular main graft portion removed, creating an aortic plug that excludes the abdominal aorta while maintaining perfusion to the visceral organs. The BEVAP device is deployed using a femoral approach, and the branches are accessed through an axillary approach. A standard axillobifemoral bypass is created to perfuse the lower body. One to 2 days later, the infected infrarenal graft is resected without the need of aortic clamping or closure of the aortic stump. The BEVAP device in these 2 cases resulted in thrombosis of the abdominal aorta and the infected graft prior to explantation. Conclusion: Using the BEVAP enables radical treatment of selected patients with hostile anatomy and infrarenal aortic graft infections who have an aneurysmal paravisceral aortic segment that prevents traditional radical surgical treatment with in situ reconstruction or extra-anatomical bypass.

Extra-anatomical ascending-thoraco-abdominal bypass for aortic fistula after thoracic endovascular aortic repair.

Aortobronchial and aorto-oesophageal fistulae after thoracic endovascular aortic repair (TEVAR) for traumatic aortic injuries are rare but serious. Potentially fatal complications may occur years after the stent graft deployment. Surgical management is challenging. We report on a 33-year-old male with aorto-oesophageal fistula and a 25-year-old male with aortobronchial fistula-both of whom received TEVAR for traumatic aortic injury. Each underwent successful staged open surgical repair with extra-anatomical bypass from the ascending aorta to the thoraco-abdominal aorta, along with arch vessel reconstructions and debridement of infected lesions. They remained alive after 18 months.

Trans-iliac Bypass for Critical Limb Ischaemia with Groin Necrosis: A Case Report.

INTRODUCTION: Infections at the level of the groin involving native or prosthetic vessels are typically bypassed using the obturator canal. However, extensive wounds or infections, particularly those involving the medial compartment of the thigh, can preclude this approach. REPORT: A 66 year old male with diabetes mellitus presented after several previous revascularisations of the femoral artery with extensive necrosis of the groin and critical limb ischaemia with necrotic changes in the toes. An iliopopliteal bypass through the iliac wing was planned because of the extent of the infection. DISCUSSION: The post-operative course was uneventful with complete resolution of tissue loss at one year follow up.

[Extra-anatomical bypass grafting of the thoracic aorta in a female patient with an infected pseudoaneurysm]. / Ékstraanatomicheskoe shuntirovanie grudnoi aorty u bol'noi s infitsirovannoi lozhnoi anevrizmoi.

Presented herein is the remote (more than 15-year follow up) result of successful surgical treatment of aortic coarctation complicated by septic aortitis and a false aneurysm of the anastomosis between the graft and the aortic arch. In 2002, after correction of aortic coarctation the woman was admitted to our Clinic with an incompetent proximal anastomosis and an infected aortic pseudoaneurysm. Taking into consideration the general and local septic process, repeat reconstruction of the thoracic aorta was impossible due to the risk for generalization of the infectious process and fatal complications. Therefore, the woman was subjected to extra-anatomical bypass grafting of the thoracic aorta with a synthetic graft from the ascending aorta to the infrarenal portion of the abdominal aorta in order to isolate the infection focus to be followed by removal thereof. The postoperative period turned out uneventful, with no complications. After 15 years, the woman was examined again, with her condition being stable. The findings of contrast-enhanced magnetic resonance imaging demonstrated complete patency of the extra-anatomical bypass graft. The carotid-subclavian anastomosis functioned well, without narrowed portions. No infectious complications after the carried out operations were observed. Using extra-anatomical bypass grafting with exclusion from circulation and removal of the infected portion of the aorta along with the graft is one of reliable variants of treatment for such a severe complication as an infected false aneurysm.