Abstract
The disruption of the body of an expanded polytetrafluoroethylene (EPTFE) graft is an extremely uncommon complication. We report a patient who suffered the disruption of an EPTFE two years after a left obturator foramen bypass. A 59-year-old man was seen in the emergency room of our hospital due to the sudden onset of painful pulsatile mass at the medial aspect of the left thigh. Two years earlier, he had undergone an extra-anatomical bypass via a left obturator foramen using a ringed EPTFE graft, 7 mm in diameter because of the infectious inguinal psuedoaneurysm of prosthetic graft. Computed tomography and ultrasonography demonstrated the disruption of graft and an aneurysm in non-anastomotic portion. The patient underwent emergency operation under general anesthesia. Proximal and distal control was obtained with clamps, and when the mass was removed, it was evident that the circumference of the graft was completely disrupted and surrounded by a large clot, forming a false aneurysm. There was no evidence of infection. After complete excision of the disrupted graft with pseudoaneurysm, and a new segment of the ringed EPTFE graft was interposed. The patient recovered uneventfully with normal wound healing. Scanning electron microscopy of the excised specimen revealed that fibrils nearside the disruption site were stretched and interval between the nodes was extended. When tension is applied along the axis of obturator foramen bypass graft during walking,leg exercise and hip joint flexion, the pulling force is frequently concentrated in the region of the graft in the thigh. We think that the repeated stretched strength causes the unique disruption of the EPTFE graft, which wall was stretched easily in a circumferential direction but great difficulty in a longitudinal direction.
