Major groin complications following the use of synthetic grafts

The ideal results of vascular reconstructive surgery include an uncomplicated operation, symptomatic relief, prompt wound healing, rapid return to pre-operative functional status without long term functional consequences. Long term complications are often not emphasized. This study describes false femoral aneurysms (FFA) and infection following use of synthetic graft in the groin.

All patients under the care of one surgeon, undergoing synthetic graft insertion involving the groin between January 1988 and December 2005 were included.

Some 489 patients were included (745 at risk groins). A total of 34 patients developed either FFA or infection, involving 39 groins (5.2%). There were 18 FFA, presenting a median of four years after the original operation. FFA was more common following aortofemoral bypass grafts than femorofemoral or femorodistal bypasses (P=0.0084). Repair with interposition grafting was carried out in 17 cases. There was one death postoperatively. The remainder remained satisfactory at a median follow up of 60 months. Median time from original operation to 21 groin infections presenting was 12 months. Infection was commonest after femorofemoral cross over grafts P=0.023. Four major amputations were carried out. Debridement and sartorius transposition was useful in about half of the cases treated.

Serious groin complications occur in about 5% of cases following use of a synthetic graft. This can result in significant morbidity long after the original operation has been carried out. Patients need to be made aware of this when obtaining informed consent.