Abstract
A graft infection is one of the most fatal complications of surgical treatment for arteriosclerosis obliterans. Both re-do arterial revascularization for limb salvage and prevention of recurring infection are necessary for the treatment of infected prosthetic graft, therefore the selection of surgical strategy for this kind of post-operative complication is extremely challenging.
A 79-year-old man was admitted to our hospital complaining of high grade fever and unbearable pain in the left groin. He had undergone femoro-popliteal bypass (above the knee) using a prosthetic graft and a popliteal graft - posterior tibial artery bypass with autologous saphenous vein graft, 4 months previously. Computed tomography on re-admission revealed an abscess formation around the prosthetic graft in the left groin. He underwent removal of the infected prosthetic graft and re-do femoro-popliteal bypass using an ePTFE graft (Distaflo), followed by reconstruction of the newly bypassed route by penetrating an iliac bone. Although his general condition steadily recovered postoperatively, the surgical site infection recurred in his left thigh. After debridement of the infected area, sartorius muscle flap transposition was performed on the 39th postoperative day. Following this, plastic surgical procedure, vacuum-assisted closure therapy was performed, and the wound had completely healed by the 60th postoperative day. In performing re-arterial revascularization of a prosthetic vascular graft infection, reconstructing the newly bypassed route by penetrating an iliac bone is one of the most effective advantageous treatments, because this strategy can help selection of an accessible bypass route, isolate the infected site, and completely eradicate the infection to facilitate wound healing. To the best of our knowledge, this is the first report of prosthetic vascular graft infection in the groin successfully treated by penetrating an iliac bone as a new bypass route for re-do arterial reconstruction.
