Common femoral artery injury by blunt trauma: a case report

Blunt injury to the common femoral artery with associated extensive soft tissue damage presented significant problems in arterial reconstruction as exemplified in this case report. Arterial restoration resolved into three phases. Initially, the femoral artery was replaced with an ipsilateral saphenous vein graft; in the second phase for septic complications, an axillofemoral bypass graft was used; and in the third phase, the contralateral saphenous vein graft was placed sequentially from the common iliac to the deep femoral to the superficial femoral to the popliteal artery. The contralateral saphenous vein had been placed in an arterialized circuit for 9 months before its harvest by means of a distal arteriovenous fistula. The primary consideration was to enlarge the small vein to approximate the caliber of the external iliac and common femoral artery. Of secondary concern was the potential for delayed aneurysmal degeneration as reported incidence in much higher in younger patients. Whether in situ arterialization influences this outcome is yet to be documented. At 36 months the saphenous vein graft is palpably normal and the ankle-brachial index is 1.0.