Abstract
Graft infection is one of the most fatal complications after surgical treatment for arteriosclerosis obliterans. Both redo arterial revascularization for limb salvage and prevention of recurrent infection are necessary to deal with the infected prosthetic graft. Therefore, surgical strategy is extremely troublesome and challenging. We successfully performed redo axillo-superficial femoral bypass by tunneling above the iliac crest for graft infection in the groin. An 82-year-old woman was referred to our hospital for suffering from intermittent claudication. Computed tomography (CT) revealed occlusion in the bilateral external iliac arteries, and right axillo-bilateral common femoral bypass was performed. One year later, a lymphocele developed in the left groin, which required for re-treatment of the inguinal wound. However, wound infection was occurred 2 months after the treatment. Staphylococcus aureus was found from the wound swab. Although the infection involved the bypass graft, it was limited around the left groin. We performed left axillo-superficial femoral bypass using a knitted 8 mm Dacron graft, followed by excising the infected graft and left common femoral artery. The graft was tunneled above the iliac crest by scraping off the upper edge of the bone to avoid skin perforation, graft kinking or compression, and led to the mid superficial femoral artery for distal anastomosis. Postoperative 3-dimensional CT angiography showed the patent graft in a proper position. The postoperative course was uneventful. We concluded that this extra-anatomic bypass was a safe procedure and an excellent option for patients with infected vascular prosthetic graft in the groin after previous revascularization.
