Multifarious complications after vascular reconstructive surgery. Diagnostic and therapeutic errors

This report is concerned with a short review of 3 reported cases in which rare successive complications occurred in various lapses of time after vascular reconstructive operations. In one, 38 year old man, in a 12 year period after primary endarterectomy of aortic bifurcation and common iliac arteries the following complications occurred consecutively: an aneurysmal formation in the iliac artery with urethero-aneurysmal fistula and severe bleeding from the urinary tract, entero-prosthetic fistula with severe gastro-intestinal bleeding, occlusion of the left iliac artery with severe left leg ischaemia. They were surgically corrected each time with a satisfactory result. In another, a 25 year old man, a traumatic lesion of the iliac artery with false aneurysmal formation took place. After an emergency excision of the aneurysm with graft replacement, early bleeding occurred from the operative wound. It was treated conservatively, which resulted in infection of the graft and crawling sepsis which lasted 6 months. Urethero-prosthetic fistula and occlusion of the femoral artery occurred. It was corrected surgically with a satisfactory result. The last case concerned a 53 year old man with atherosclerotic occlusion of the abdominal aorta, external iliac and femoral arteries. An aorto-bilateral femoral bypass graft was instituted in him. In 10 days, complete gangrene of the sigmoid colon with perforation occurred. Sigmoidectomy with colostomy were performed. After that, further complications developed: (1) massive venous thrombosis of the left leg and (2) progressive left buttock necrosis. The last complication resulted in septicemia and death of this patient after 3 months of treatment.