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Reconstruction with the use of autologous femoropopliteal veins for an infected aortobifemoral bypass graft

A 70-year-old man presented with left groin swelling 8 weeks after an aortobifemoral bypass graft (Dacron). The indication for an aortobifemoral bypass graft was a worsening short-distance claudication owing to an occluded aorta, right common iliac and left external iliac arteries (figure 1). His medical history included type 2 diabetes, hypertension, chronic obstructive pulmonary disease and atrial fibrillation. The patient was a non-smoker with alcohol consumption allowance below 21 units/week.



Figure 1 
CT angiography showing an aortoiliac disease.



Upon examination, the patient had a temperature of 38.4°C and a heart rate of 109/min. Blood pressure and oxygen saturation were normal. Examination of respiratory system was unremarkable. Heart sounds were normal with no murmurs. Abdomen was soft and non-tender with healed scars. A detailed peripheral vascular examination demonstrated the left groin swelling with transmitted pulsation, which was not expansile. There was no tissue loss and pedal pulses were present bilaterally.

The patient was admitted, and an emergency ultrasound scan (US) of the left groin was performed to rule out the presence of pseudoaneurysm. The US showed reactive lymph nodes in the groin and heterogeneous collection (1.8×2.1 cm) superiorly to the graft with no obvious flow within the collection. Subsequently, a CT angiography confirmed an isolated left groin collection (figure 2). Laboratory tests showed elevated white cell count (WBC) of 14×10 g/l and …