Klebsiella Mycotic Aortic Aneurysm: Thoracoabdominal aortic aneurysm repair

A middle-aged male with history of Klebsiella bacteremia presented with abdominal pain and fever. CT scan showed a pseudoaneurysm at the level of the superior mesenteric and renal artery level. Patient's bacteremia cleared with appropriate antibiotics however, the pseudo-aneurysm increased in size and the patient experienced persistent back and abdominal pain. The patient underwent a type IV thoracoabdominal aortic aneurysm repair. There was massive inflammation of the retroperitoneal space from just above the diaphragm to the aortic bifurcation. There was frank pus upon opening the pseudo-aneurysm with a large abscess cavity abutting the vertebral column. The intra-operative photo shows the main aortic graft which is connected to another multi-branched graft that connects to the celiac artery, SMA, and both renal arteries. The patient will receive 12 week course of IV antibiotics and life-long suppressive antibiotic regimen.