Bilateral splenorenal bypass and axillofemoral graft for management of juxtarenal mycotic aneurysm

The principles of treatment of mycotic aortic aneurysms are not well established and the optimal method of revascularization — extra-anatomic bypass or in situ grafting — is still debated. Infection of the juxtarenal or suprarenal aorta poses an additional challenge in management because of the requirement for visceral revascularization. The case of a 73-year-old man is reported who developed several mycotic aneurysms of the juxtarenal, infrarenal aorta and right main iliac artery following a Candida infection. He was successfully treated with suprarenal aortic ligation, aneurysmal excision, splenorenal bilateral bypass and systemic antifungal therapy. The patient subsequently underwent extra-anatomic revascularization of the lower extremities with a left axillobifermoral bypass involving a polytetrafluoroethylene graft.