Perigraft lipid accumulation with unusual complications in a hyperlipidemic patient

A 50-year-old man with hyperlipidemia, on long-term clofibrate therapy, 2 g/day, developed a series of unusual complications after insertion of a Dacron bifurcation graft from the aorta to the right popliteal and left femoral arteries. There were false aneurysms at all graft-to-artery suture lines, and a clinical picture of peripheral cholesterol emboli developed. At operation, a lipid accumulation under pressure was found between the graft and the perigraft adventitia. The perigraft adventitia later ruptured and a psoas muscle xanthomatous inflammatory mass developed, causing an acute abdomen; a second operation was performed. The mechanism of formation of the perigraft lipid accumulation and the relationship of this unusual sequence of complications to the hyperlipidemia or its treatment with clofibrate are discussed.