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Aortobifemoral Reconstruction with Right Extra-Anatomic Obturator Foramen Bypass due to a Septic Groin
Carlos A Hinojosa1, Javier E Anaya-Ayala1, Hugo Laparra-Escareno1
1Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, Instituto Nacional de Ciencias Médicas y Nutrición "Salvador Zubiran", Mexico City, Mexico.
Insights
Obturator bypass is a safe and effective technique for aortobifemoral reconstruction in patients with infected groins, avoiding complications and maintaining vascular continuity. This method offers durable results with a high secondary patency rate.
Area of Science:
- Vascular Surgery
- Atherosclerotic Occlusive Disease
Background:
- Leriche's syndrome, characterized by atherosclerotic occlusive disease in the aortic bifurcation and iliac vessels, presents surgical challenges, especially with coexisting groin infections.
- Aortobifemoral bypass grafting is a standard treatment, but septic groin complications complicate the procedure.
Observation:
- A 65-year-old male with complete distal aorta and iliac artery occlusion, previously treated with axillo-femoral and femoral-femoral bypass, presented with a complex right groin graft infection and worsening lower extremity ischemia.
- A novel aortobifemoral reconstruction was performed using the right obturator membrane to bypass the infected groin area.
Findings:
- The obturator bypass technique successfully reconstructed the aortobifemoral vessels, circumventing the infected groin.
- The procedure demonstrated safety and efficacy, preserving vascular continuity and graft durability.
Implications:
- The obturator bypass offers a viable alternative for complex aortobifemoral reconstructions in patients with infected groins, reducing the risk of further complications.
- This technique achieves a significant secondary patency rate of 78 months, highlighting its long-term efficacy.
Abstract:
The aortic bifurcation and iliac vessels are common sites of atherosclerotic occlusive disease causing the clinical expression known as "Leriche's syndrome". An aortobifemoral bypass grafting in the setting of a septic groin remains a significant challenge to vascular surgeons. We present a 65-year-old male with complete occlusion of the distal aorta and iliac arteries; he had undergone a left axillo-femoral and femoral-femoral artery bypass 2 years prior to our evaluation. Owing to a complex graft infection in the right groin and worsening lower extremity ischemia, we performed an aortobifemoral reconstruction through the right obturator membrane. This report highlights the safety and efficacy of the obturator bypass for avoiding infected groins while preserving vascular continuity and durability with 78 months of secondary patency rate.
