Massive atheromatous emboli to both kidneys: a fatal complication following aortic surgery

A patient with severe and diffuse ulcerative atherosclerotic arterial disease developed acute renal failure and anuria during insertion of an aortobifemoral graft. Postoperative septicemia, with Pseudomonas aeruginosa and Streptococcus fecalis, led to a deterioration in his condition and death. At autopsy the Dacron bifurcation graft showed no sign of infection, but massive atheromatous emboli of recent origin were found in both kidneys. We suggest using an extra-anatomic approach in reconstructive surgery for occlusive disease of the abdominal aorta in patients with ulcerative atheroma.