Implantation of a composite bifurcated cryopreserved aorto-iliac-femoral homograft in a patient with Candida albicans endocarditis

A 35 year old woman, cocaine addict, suffered Candida albicans aortic valve endocarditis complicated with embolisation of infected vegetations in the distal abdominal aorta. She underwent successful staged aortic valve replac ement followed by transaortic and transfemoral thrombectomy. One month late r an arteriogram disclosed partial occlusion of the left iliac artery, bila teral aneurysmal degeneration of both iliac arteries and right iliac artery -right iliac vein fistula. She was operated again, performing re-laparotomy and re-exploration. A composite bifurcated cryopreserved homograft was imp lanted end-to-side between the infrarenal abdominal aorta, right external i liac artery and left common femoral artery. The right iliac artery-iliac ve in fistula was obliterated with suture. The patient had an uneventful recov ery but a relapsing arterio-venous fistula was diagnosed by arteriography. Three months later she underwent percutaneous transluminal closure of the r eopened fistula. At present, 17 months after the implantation of the homogr aft, the patient is symptom-free, on antifungal agents and with arteriograp hic and clinical evidence of a well-functioning arterial homograft.