Thoracic endovascular aneurysm repair of a ruptured zone 0 mycotic thoracic aortic aneurysm

A 48-year-old woman presented with an acute type B aortic dissection. Despite medical management with anti-impulse therapy in intensive care, she continued to have chest and back pain and underwent aortic arch debranching and thoracic endovascular aneurysm repair (TEVAR). Her post-operative course was complicated by sternal and mediastinal infection. Several weeks later, the patient developed acute onset chest pain and computed tomography angiogram revealed contrast extravasation just proximal to the endograft. Emergent zone 0 TEVAR was performed with exclusion of hemorrhage and continued filling of the debranched vessels. Post-operatively, fevers continued despite 6 weeks of antibiotic treatment and phage therapy was prescribed for 5 days. At 2-year follow-up, there was no recurrence of infection.