Abstract
A 61-year-old man underwent a right-to-left femorofemoral crossover bypass using an artificial conduit for occlusion of the left common iliac artery. He was referred to our department 2 weeks later with fever and purulent exudate from the left groin. The wound was opened for debridement and rinsed with warm saline every day for two weeks. Methicillin-resistant Staphylococcus aureus was grown from a groin culture. After the infectious inflammation was brought under control, the patient underwent graft removal. Immediately after the second operation, the left leg developed acute ischemia. A crossover bypass using a greater saphenous vein graft was performed. A proximal anastomosis was made at the right external iliac artery, and the graft was tunneled through the preperitoneal space. Distal anastomosis was made with a 5-cm onlay patch from the left external iliac artery to the common femoral artery. At 36 months, he had no evidence of recurrent infection, and the graft remained patent. The treatment of infected femorofemoral crossover bypass grafts is a difficult problem. We suggest that reconstruction with a saphenous vein graft passing behind the rectal muscle is a viable option. Long onlay anastomosis from the external iliac artery to the common femoral artery might diminish the risk of vein graft kinking.
