Management of Popliteal Artery Interposition Graft Infection by Extra-anatomic Bypass

Area of Science:

• Vascular Surgery
• Infectious Disease Management

Background:

• Peripheral interposition graft infection is a rare but severe complication of aneurysm repair.
• Management varies based on infection location and extent, often requiring graft explantation and limb revascularization.

Purpose of the Study:

• To describe the successful management of a popliteal artery interposition graft infection.
• To highlight a two-stage surgical approach for complex popliteal graft infections.

Main Methods:

• A two-stage surgical procedure was performed on an 84-year-old male with a history of popliteal artery aneurysm repair.
• Stage 1 involved a superficial femoral artery to posterior tibial artery bypass using reversed great saphenous vein.
• Stage 2 included prone repositioning for posterior debridement of the infected popliteal fossa, graft removal, and placement of antibiotic beads.

Main Results:

• The patient retained motor function, sensation, and palpable pulses post-operatively.
• Serial washouts and a 6-week course of IV cefazolin followed by oral suppression achieved successful limb salvage.

Conclusions:

• Popliteal artery graft infections pose significant management challenges due to the risk of recurrent infection and proximity to vital structures.
• A staged surgical approach with meticulous debridement and limb revascularization is crucial for favorable outcomes.