Title: Superficial femoral artery as a graft material by performing an iliacofemoral in situ bypass for leg stump salvage: Case report

Authors: Mestric A. M.D.

 DOI: https://dx.doi.org/10.18535/jmscr/v6i12.75

Abstract

Introduction

Once infection occurs after vascular operations with grafts, it might result  in a serious disaster. According to statistics, both early (within 4 months after operation) and late (more than 4 months after operation), one forth to one half,  is caused by Staphylococcus aureus.1

Blood- borne bacteria from intravenous lines or systemic infections may also cause graft inoculation and sepsis.2

Prosthetic graft infection can present at any time from days to years after surgery with pyrexia, systemic sepsis, local abscesses and sinuses, graft exposure, thrombosis or anastomotic haemorrhage.2

In contradistinction to infected aortic grafts, infected peripheral bypass grafts pose greater risk to loss of limb as opposed to loss of life, although sepsis and bleeding complications can occur and have devastating outcomes.3

The mainstay of vascular graft infection management is as follows. First, excision of the graft, as this as a foreign body  may potentiate the infection. Second, wide and complete debridement of devitalised and infected tissue to provide a clean wound in which healing can occur. Third, establishing a vascular flow to the distal bed. Fourth, intesive and prolonged treatment with antibiotics, to reduce the risk for sepsis and secondary graft infection. 2

Reconstruction options for the in situ approach include in-line placement of a prosthetic graft or tissue graft, with the latter encompassing arterial allografts, venous allografts, and venous autografts.3

We aim to report a case of 58-year-old female who presented with active bleeding as a result of artery wall erosion through infection, 3 months after performing of plastic repair on profound femoral artery (PFA) with bovine pericardial patch.

References

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Corresponding Author

Mestric A. M.D.

Department of cardiovascular surgery, Heart Center Bad Segeberg, Germany