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Aortic Graft Infection Secondary to Iatrogenic Transcolonic Graft Malposition

Jacqueline J Blank1, Abby E Rothstein2, Cheong Jun Lee2

  • 11 Division of Colorectal Surgery, Department of Surgery, Medical College of Wisconsin, Milwaukee, WI, USA.

Vascular and Endovascular Surgery
|March 21, 2018
PubMed

Insights

Iatrogenic misplacement of aortobifemoral bypass grafts through the colon is rare. This complication can lead to graft infection, requiring explantation and extra-anatomic bypass for recovery.

Area of Science:

  • Vascular Surgery
  • Surgical Complications

Background:

  • Aortic graft infections are rare but serious complications following aortic revascularization.
  • Surgical contamination is a common cause of these infections.
  • Iatrogenic misplacement of aortobifemoral grafts is exceedingly rare, with undefined treatment principles.

Observation:

  • Two cases of aortobifemoral bypass graft malposition through the colon are presented.
  • Case 1 involved a 54-year-old male with graft placement through the sigmoid colon, presenting with an occult infection 6 months post-surgery.
  • Case 2 involved a 60-year-old male with graft placement through the cecum, presenting with acute symptoms including fever and bacteremia 10 weeks post-surgery.

Findings:

  • Both patients had their aortobifemoral grafts iatrogenically misplaced through the colon during the initial surgery.
  • Graft malposition was confirmed intraoperatively in both cases.
  • Infection presentation varied, with Case 1 showing indolent symptoms and Case 2 presenting more acutely.

Implications:

  • This report highlights the critical importance of precise graft placement during aortobifemoral bypass surgery.
  • Early recognition and surgical intervention, including graft explantation and extra-anatomic bypass, are crucial for patient recovery.
  • Further research is needed to establish clear guidelines for the evaluation and management of this rare complication.
Keywords:
blood vessel prosthesis implantation/adverse effectsblood vessel prosthesis implantation/instrumentationblood vessel prosthesis implantation/mortalityperipheral vascular diseasevascular prostheses

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