Abstract
The rupture of the artificial vascular graft is a rare complication. This report describes a case of disruption of a ringed ePTFE graft in the mid-point of a left axillofemoral bypass. A 62-year-old man stumbled on the road and bruised his abdomen knocking against the concrete. He had undergone a left axillofemoral bypass procedure using a ringed ePTFE graft, 8 mm in diameter, 14 years previously for the atherosclerotic obstruction of his left common iliac artery. He came to the emergency department and a physical examination revealed a large hematoma at the site of the ePTFE graft on his left lateral abdominal wall. The patient was hemodynamically stable, with a blood pressure of 143/76 mmHg, and pulse rate of 87 beats/min. CT showed the disruption of the ePTFE graft and a pseudoaneurysm 2 cm in diameter about 15 cm cranial side from the disrupted portion. The patient underwent emergent surgery under general anesthesia. Intravenous heparin was not used during the operation because he had been administered warfarin 2.5 mg/day and PT-INR was 3.24 when he came to our hospital. An incision was made on the hematoma and the graft was dissected free. The graft was clamped above and below the lesion using forceps. When the mass was entered, it was evident that the graft was completely divided. The cut edge was smooth and there was no need of trimming. Two rings were peeled off and end-to-end anastomosis was created with 5-0 Prolene sutures. Pseudoaneurysm was not repaired because it was not critical. Postoperative CT at 7 days revealed no extravasation. Convalescence was uneventful and the patient was discharged on the 14th postoperative day without leg pain or claudication. Not only the effects of external forces but also the deterioration of the graft seemed to be the cause of the disruption in this case. Our case report demonstrates the potential for disruption of the midportion of ringed ePTFE axillofemoral bypass graft with direct blunt trauma.
