Intraoperative endotoxin adsorption as a new therapeutic option for mycotic aortic aneurysm.

An 82-year-old man with a mycotic aortic aneurysm of the distal arch underwent urgent surgery because of sepsis. The infected aortic arch was excised, replaced with a rifampicin-bonded prosthetic graft, and covered with omentum. Direct hemoperfusion using polymyxin B-immobilized fiber (PMX-DHP) was intraoperatively carried out in parallel with the cardiopulmonary circuit. Intraoperative PMX-DHP dramatically reduced the level of plasma endotoxin, and ameliorated hemodynamic instability and oxygenation, resulting in smooth weaning from cardiopulmonary bypass. Intraoperative endotoxin adsorption is technically simple and easy, effective in hemodynamic stabilization, and so could be a new therapeutic option for mycotic aortic aneurysm.