"Holey Moly" - Comprehensive Management of an Eroded Aortic Prosthetic Graft

Video Transcription

Video Summary

In this video, titled "Holy Moly, Comprehensive Management of an Eroded Aortic Prosthetic Graft," a 45-year-old male with a history of intravenous drug abuse presented with a ruptured mycotic aortic aneurysm. He underwent thoracic and vascular aortic repair but later developed fevers. CT angiography revealed fluid and air around his aortic graft, with a defect in the esophagus located 31 centimeters from the incisor. Surgical endoscopy was consulted for management, and after five rounds of endoscopic debridement and vacuum therapy, a two-stage procedure was conducted to address the esophageal defect. Endoscopic-assisted drain placement and closure of the defect were successful. The patient had no complications and a three-month postoperative visit showed no symptoms. However, a postoperative swallow study raised concerns for an ongoing aortoesophageal fistula. The defect was closed endoscopically using an over-the-scope clip. No complications were reported, and subsequent endoscopies showed no evidence of ongoing communication or exposed graft. The video emphasizes the importance of comprehensive endoscopic management, collaboration between different surgical specialties, and familiarity with various endoscopic defect closure tools.

Keywords

Aortic Prosthetic Graft

Eroded Aortic Graft

Mycotic Aortic Aneurysm

Endoscopic Management

Aortoesophageal Fistula