Aortic Graft Infection Secondary to Iatrogenic Transcolonic Graft Malposition

Abstract

Context: 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 two 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 six 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 aorto bifemoral 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 ten 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.

Femur Osteomyelitis and Associated Fracture as an Initial Presentation of Aortoenteric Fistula

“…Based on the literature, there have already been reports of iatrogenic perforation of the colon during tunneling of an aortobifemoral graft; however, our patient exhibited a unique presentation. 5 To the best of our knowledge, there have been no other similar cases of pathological fracture as an initial presentation of underlying aortoenteric fistula in the English literature. In our case, the aortoenteric fistula led to periaortic inflammation that infiltrated the surrounding tissues.…”