Faculty Collaboration Database

Aortic Graft Infection Secondary to Iatrogenic Transcolonic Graft Malposition. Vasc Endovascular Surg 2018 Jul;52(5):386-390

Date

03/21/2018

Pubmed ID

29554857

DOI

10.1177/1538574418764037

Scopus ID

2-s2.0-85044326604 (requires institutional sign-in at Scopus site)   5 Citations

Abstract

UNLABELLED: Aortic graft infections are a rare but devastating complication of aortic revascularization. Often infections occur due to contamination at the time of surgery. Iatrogenic misplacement of the limbs of an aortobifemoral graft is exceedingly rare, and principles of evaluation and treatment are not well defined. We report 2 cases of aortobifemoral bypass graft malposition through the colon.

CASE REPORT: Case 1 is a 54-year-old male who underwent aortobifemoral bypass grafting for acute limb ischemia. He had previously undergone a partial sigmoid colectomy for diverticulitis. Approximately 6 months after vascular surgery, he presented with an occult graft infection. Preoperative imaging and intraoperative findings were consistent with graft placement through the sigmoid colon. Case 2 is a 60-year-old male who underwent aortobifemoral bypass grafting due to a nonhealing wound after toe amputation. His postoperative course was complicated by pneumonia, bacteremia thought to be secondary to the pneumonia, general malaise, and persistent fevers. Approximately 10 weeks after the vascular surgery, he presented with imaging and intraoperative findings of graft malposition through the cecum.

CONCLUSIONS: Aortic graft infection is usually caused by surgical contamination and presents as an indolent infection. Case 1 presented as such; Case 2 presented more acutely. Both grafts were iatrogenically misplaced through the colon at the index operation. The patients underwent extra-anatomic bypass and graft explantation and subsequently recovered.

Author List

Blank JJ, Rothstein AE, Lee CJ, Malinowski MJ, Lewis BD, Ridolfi TJ, Otterson MF

Authors

Jacqueline Blank MD Assistant Professor in the Surgery department at Medical College of Wisconsin
Brian D. Lewis MD Professor in the Surgery department at Medical College of Wisconsin
Michael Malinowski MD Associate Professor in the Surgery department at Medical College of Wisconsin
Mary F. Otterson MD Professor in the Surgery department at Medical College of Wisconsin
Timothy J. Ridolfi MD, MS, FACS Associate Professor in the Surgery department at Medical College of Wisconsin
Abby Rothstein MD Assistant Professor in the Surgery department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Anti-Infective Agents
Aorta
Aortography
Blood Vessel Prosthesis
Blood Vessel Prosthesis Implantation
Colectomy
Colon
Computed Tomography Angiography
Device Removal
Diverticulitis, Colonic
Humans
Male
Medical Errors
Middle Aged
Prosthesis-Related Infections
Treatment Outcome