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Vasc Endovascular Surg. 2018 Jul;52(5):386-390. doi: 10.1177/1538574418764037. Epub 2018 Mar 19.

Aortic Graft Infection Secondary to Iatrogenic Transcolonic Graft Malposition.

Author information

1
1 Division of Colorectal Surgery, Department of Surgery, Medical College of Wisconsin, Milwaukee, WI, USA.
2
2 Division of Vascular Surgery, Department of Surgery, Medical College of Wisconsin, Milwaukee, WI, USA.

Abstract

Aortic graft infections are a rare but devastating complication of aortic revascularization. Often infections occur due to contamination at the time of surgery. Iatrogenic misplacement of the limbs of an aortobifemoral graft is exceedingly rare, and principles of evaluation and treatment are not well defined. We report 2 cases of aortobifemoral bypass graft malposition through the colon.

CASE REPORT:

Case 1 is a 54-year-old male who underwent aortobifemoral bypass grafting for acute limb ischemia. He had previously undergone a partial sigmoid colectomy for diverticulitis. Approximately 6 months after vascular surgery, he presented with an occult graft infection. Preoperative imaging and intraoperative findings were consistent with graft placement through the sigmoid colon. Case 2 is a 60-year-old male who underwent aortobifemoral bypass grafting due to a nonhealing wound after toe amputation. His postoperative course was complicated by pneumonia, bacteremia thought to be secondary to the pneumonia, general malaise, and persistent fevers. Approximately 10 weeks after the vascular surgery, he presented with imaging and intraoperative findings of graft malposition through the cecum.

CONCLUSIONS:

Aortic graft infection is usually caused by surgical contamination and presents as an indolent infection. Case 1 presented as such; Case 2 presented more acutely. Both grafts were iatrogenically misplaced through the colon at the index operation. The patients underwent extra-anatomic bypass and graft explantation and subsequently recovered.

KEYWORDS:

blood vessel prosthesis implantation/adverse effects; blood vessel prosthesis implantation/instrumentation; blood vessel prosthesis implantation/mortality; peripheral vascular disease; vascular prostheses

PMID:
29554857
DOI:
10.1177/1538574418764037
[Indexed for MEDLINE]

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