Vaskulárna medicína 3/2016

Aortobifemoral bypass graft infection – a case report

Graft infection is one of the most serious complications in vascular surgery. Authors describe case report of sixty four year old woman who developed signs of graft infection five years after aortobifemoral bypass grafting. Infection was definitely treated by explantation of aortobifemoral graft and limb revascularization was performed by extraanatomical axilobifemoral bypass. Incidence of graft infection is 0,2-5%. The most common pathogen causing graft infection is Staphylococcus aureus.Diagnosis of graft infection is based on clinical signs of infection, elevation of inflammatory markers and CT or PET-CT. Treatment of graft infection is based on intravenously administered antibiotics and explantation of infected graft. Only localized graft infections can be treated by excision of infected part of the prothesis. Limb revascularization after graft removal can be provided by extraanatomical bypass or in situ arterial reconstruction. Extraanatomical axilobifemoral bypass is treatment of choice in the case of virulent infections Staphylococcus aureusor gram negative infections (G- infections) and has 25% perioperative mortality and 22% limb loss. Superficial femoral vein used for in situ reconstruction seems to have lower perioperative mortality and limb loss compared to extraanatomical axilobifemoral bypass. In situ bypass is reserved for less virulent infections (Staphylococcus epidermidis).

Keywords: graft infection, aortobifemoral bypass, axilobifemoral bypass, extraanatomical bypass