title: An unusual late complication of axillobifemoral bypass graft: a case report.
abstract: Axillobifemoral bypass is a well-established surgical procedure performed in conditions that preclude direct arterial reconstruction due to aortic sepsis, aortoenteric fistula, or other hostile abdominal pathology or prohibitive surgical risk. The choice of prosthetic graft used is either knitted Dacron(R) or polytetrafluoroethylene, with equally good results. Although externally supported grafts reportedly yielded improvement in primary patency compared to historical controls, no consensus exists as to which demonstrates superiority over the other despite several retrospective studies. Complications are usually limited to the perioperative period, although late anastomotic disruption, graft thrombosis, axillary thromboembolism, pseudoaneurysm formation due to seat belt trauma, and hemorrhage or graft rupture have all been described. In addition to the above complications responsible for graft failure, perigraft infection, intimal hyperplasia, poor distal runoff, anastomotic fibrosis, and comorbid conditions may contribute to graft failure. We describe an unusual late complication of an axillobifemoral bypass graft whereby an organized thrombus within the layers of the bypass graft led to luminal compromise and, hence, attenuation of flow and resultant "failing graft."
authors.affiliation: Department of Cardiology, Tufts-New England Medical Center, Boston, MA 02135, USA. klotun@yahoo.com
authors.forename: Kapildeo
authors.initials: K
authors.lastname: Lotun
authors.forename: Robert M
authors.initials: RM
authors.lastname: Schainfeld
authors.forename: Syed
authors.initials: S
authors.lastname: Razvi
authors.forename: Sung
authors.initials: S
authors.lastname: Cho
authors.forename: William T
authors.initials: WT
authors.lastname: Irwin
authors.forename: Andre
authors.initials: A
authors.lastname: Gribben
authors.forename: Frank K
authors.initials: FK
authors.lastname: Chong
mesh_terms: D000368:Aged; D000792:Angiography; D001366:Axillary Artery / Q000601:surgery*; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects*; D020878:Device Removal; D005263:Femoral Artery / Q000601:surgery*; D006083:Graft Occlusion, Vascular / Q000209:etiology* / Q000473:pathology / Q000601:surgery; D006801:Humans; D007383:Intermittent Claudication / Q000601:surgery; D008297:Male; D011474:Prosthesis Design; D013927:Thrombosis / Q000209:etiology* / Q000473:pathology / Q000601:surgery; D014057:Tomography, X-Ray Computed; D018615:Ultrasonography, Doppler, Color; D018084:Ultrasonography, Interventional