BACKGROUND: Aorto-aortic extra-anatomical bypass is a specialized surgical intervention primarily used to manage complex vascular complications, including stent graft infections after endovascular aortic repair. Stent graft infection is a rare but severe complication associated with high morbidity and mortality, which requires prompt treatment to prevent life-threatening sequelae such as pseudoaneurysm formation, aortic rupture, or fistula formation.

CASE REPORT: We describe 2 young male patients who developed infected thoracic aortic stent grafts after aortic arch debranching and endovascular repair. The first patient, a 37-year-old man with a history of traumatic aortic isthmus transection managed via tube interposition grafting 10 years earlier, presented with a proximal anastomotic pseudoaneurysm; he subsequently underwent arch debranching and endovascular stent grafting. He was later readmitted with systemic infection and mediastinal hematomas indicative of graft infection. The second patient, a 34-year-old man with Behçet disease and an aortic arch aneurysm, presented with an infected mediastinal hematoma involving the aortic stent graft after arch debranching and stent grafting. Both patients underwent stent graft explantation and extra-anatomical ascending-to-descending aorto-aortic bypass under peripheral cardiopulmonary bypass with deep hypothermic circulatory arrest. Both patients survived the complex aortic procedure and remained clinically stable at 38 and 17 months of follow-up (after the most recent procedure), respectively. One patient required additional wound management for a surgical site infection; the other underwent delayed repair of an ascending aortic pseudoaneurysm.

CONCLUSIONS: This case series demonstrates the feasibility of aorto-aortic extra-anatomical bypass as a potentially life-saving intervention for aortic endograft infection when perioperative management is optimized.

Keywords: Extra-Anatomical Aorto-Aortic Bypass, Aortic Arch Stent Graft, Deep Hypothermic Circulatory Arrest, Ascending Aortic Pseudoaneurysm, omental flap