Late rupture of prosthetic aortic grafts. Presentation and management

Eight patients were treated for complications arising from actual holes in prosthetic aortofemoral or aortoiliac grafts. All occurred more than 8 years after implantation. Presentations varied and included shock from a graft-to-enteric fistula, a rapidly expanding painful femoral aneurysm, an acutely ischemic limb, and rest pain. The whole graft is suspect and must be assessed by aortography, but graft deterioration can be localized, which simplifies management. In our patients, holes in the body of the graft or near the bifurcation were approached transabdominally. We replaced as much of the graft as was reasonable under the circumstances. Two of the four patients died. Five patients had graft holes in the inguinal region which we believe were related to tethering in that area. For this reason, we recommend cutting the inguinal ligament and prosthetic limbs no more than 8 mm in diameter. Partial retroperitoneal resection with external sleeve support has been a durable alternative to a complete redo operation in patients with degeneration isolated to the inguinal area.