Mycotic distal arch aneurysm successfully operated through L-incision approach]

A 70-year-old female who had undergone pancreato-duodenectomy 1 month before, presented with back pain. Computed tomography (CT) revealed a saccular aneurysm in the distal aortic arch (40 mm in diameter) and she was referred to our department. Despite proper antibiotic treatment, CT revealed progressive enlargement of the aneurysm and operation was performed. The aneurysm was treated by debridement of the infected aortic tissue and in situ replacement with a rifampicin-soaked vascular prosthesis through L-incision approach. After surgery, antibiotics were administrated intravenously for 1 month, followed by oral antibiotics. The patient is doing well 1 year after the operation.