ENDOVASCULAR SURGERY - AN INTEGRAL COMPONENT OF TREATMENT FOR INFECTED AORTOBIFEMORAL BYPASS GRAFTS - A CASE-REPORT

Endovascular reconstruction may be used alone or in combination with s tandard vascular techniques in dealing with infected grafts. This case report concerns a 53-year-old man who presented with sepsis 3 years a fter undergoing aortobifemoral bypass. The bypass was performed after two failed angioplasties. The proximal anastomosis was performed in an end-to-side fashion. One year prior to presenting with sepsis, the pa tient developed acute myelogenous leukemia and underwent chemotherapy with subsequent remission. Eight months later, the patient developed l ow-grade fever and chills and was treated for pulmonary infection. Per sistent mild symptoms prompted a Gallium scan that raised the possibil ity of an infected aortic graft. Subsequent computed tomography (CT) s can, magnetic resonance imaging (MRI), and Indium scan were normal. Ad mission was prompted when he presented with biopsy-documented septic e mboli to the right leg. Repeat CT scan suggested aortic graft infectio n localized to the proximal graft segment. Operative repair included a right common femoral endarterectomy, a right iliac balloon angioplast y, insertion of a right iliac Wallstent, and a right-to-left femoral-f emoral polytetrafluoroethylene (PTFE) bypass. The well-incorporated fe moral graft limbs were detached and the groins closed. Abdominal explo ration identified a jejunal-aortic graft erosion with a localized absc ess. The infected graft was removed and the aortotomy repaired with a patch fashioned from an endarterectomized portion of the occluded left external iliac artery. Small bowel resection with primary anastomosis and omental flap completed the operation. Four days postoperatively, the Wallstent required further expansion with an open balloon angiopla sty to establish palpable pedal pulses. The patient recovered uneventf ully and received a total of 6 weeks of broad-spectrum intravenous ant ibiotics. This case illustrates the use of adjunctive endovascular tec hniques in handling difficult vascular graft infections and stresses t heir importance as an integral component of the vascular surgeon's arm amentarium.