title: Femoral artery to prosthetic graft anastomotic dehiscence owing to infection: successful treatment with arterial reconstruction and limb salvage.
abstract: A 66-year-old man had foot gangrene and a fixed contracture of the knee following two failed femoropopliteal bypasses, one with vein and one with polytetrafluoroethylene (PTFE). An external iliac to anterior tibial artery bypass and skeletal traction via the os calcis resulted in limb salvage and successful normal ambulation. After 3 months, he ruptured the infected femoral anastomosis of the failed PTFE femoropopliteal bypass with external bleeding. The use of arteriography and a balloon catheter to obtain proximal control allowed arterial repair, removal of the graft, and preservation of flow within a patent common and deep femoral artery. This flow preservation maintained the viability and function of the limb when the anterior tibial bypass closed 4 years later, and the limb continues to be fully functional 3 years later. Aggressive secondary attempts at limb salvage are worthwhile even in unfavorable circumstances.
authors.affiliation: Division of Vascular Surgery, Montefiore Medical Center, University Hospital for the Albert Einstein College of Medicine, New York, NY, USA.
authors.forename: Kenneth A
authors.initials: KA
authors.lastname: Goldstein
authors.forename: Frank J
authors.initials: FJ
authors.lastname: Veith
authors.forename: Takao
authors.initials: T
authors.lastname: Ohki
authors.forename: Nicholas J
authors.initials: NJ
authors.lastname: Gargiulo
authors.forename: Evan C
authors.initials: EC
authors.lastname: Lipsitz
mesh_terms: D000368:Aged; D000714:Anastomosis, Surgical; D001807:Blood Vessel Prosthesis; D003286:Contracture / Q000628:therapy; D005263:Femoral Artery / Q000601:surgery*; D005528:Foot / Q000473:pathology*; D005734:Gangrene / Q000601:surgery; D006801:Humans; D007719:Knee Joint; D007866:Leg / Q000098:blood supply; D023821:Limb Salvage / Q000379:methods*; D008297:Male; D011138:Polytetrafluoroethylene; D016459:Prosthesis-Related Infections / Q000601:surgery*; D012086:Reoperation / Q000379:methods; D013529:Surgical Wound Dehiscence / Q000601:surgery*
chemical_list: D011138:Polytetrafluoroethylene