Carotid-Subclavian-Bypass Infection After a Hybrid Approach for Complicated Type-B Aortic Dissection.

BACKGROUND

Hybrid thoracic endovascular aortic repair (TEVAR) is increasingly used for complicated type-B aortic dissection but carries a risk of complications, including infection.

CASE SUMMARY: A 57-year-old man underwent hybrid repair with carotid-subclavian bypass (CSB) and TEVAR for complicated type-B aortic dissection. Four months later, he presented with fever and a draining fistula at the CSB site. Imaging and microbiology confirmed methicillin-sensitive Staphylococcus aureus infection. Despite surgical removal of the CSB and reinterventions, including endograft relining and ascending aorta replacement, the patient developed a fatal aorto-esophageal fistula.

DISCUSSION: This case illustrates the complexity of diagnosing and managing vascular graft infections after hybrid TEVAR. Literature confirms these infections are rare but often fatal, requiring multimodal imaging and multidisciplinary care. The case also questions routine use of CSB given the emergence of alternative techniques.

TAKE-HOME MESSAGES: CSB after hybrid TEVAR is rare but highly lethal. Early diagnosis and aggressive multidisciplinary management are critical.