title: [Rupture of venous bypass graft associated to infection of multiresistant bacteria].
abstract: We report two cases of severe trauma of the upper limb requiring arterial revascularization. A brachio-brachial inverted saphenous bypass graft was done in both cases. Graft rupture attributed to local infection occurred at fourth post-operative week. Pseudomonas aeruginosa was isolated from the surgical wound in the first case and Acinetobacter baumanni in the second. The first case ended up with arm amputation mostly owing to extensive destruction of soft tissue, the patient being discharged home without any other sequel. In the second case the patient was successfully resuscitated after cardiopulmonary arrest, secondary to hemorrhagic shock. He underwent new brachio-brachial venous bypass graft avoiding the contaminated area. Irreversible ischemic signs plus growing overt infection led to arm amputation later on. This patient developed multi-organ failure and died by the fifth post-operative week. Acinetobacter baumannii and Pseudomonas aeruginosa are gram-negative bacilli widely present in hospital environment. Most of them are resistant to commonly used antibiotics. Their association with vascular conduit infections might have dreadful consequences as it happened in these cases.
authors.affiliation: Serviço de Angiologia do Hospital de S. João, Porto.
authors.forename: José C
authors.initials: JC
authors.lastname: Vidoedo
authors.forename: Timmy
authors.initials: T
authors.lastname: Toledo
authors.forename: Sérgio
authors.initials: S
authors.lastname: Sampaio
authors.forename: Alfredo
authors.initials: A
authors.lastname: Cerqueira
authors.forename: Isabel
authors.initials: I
authors.lastname: Vilaça
authors.forename: Paulo
authors.initials: P
authors.lastname: Dias
authors.forename: Joana
authors.initials: J
authors.lastname: Carvalho
authors.forename: José
authors.initials: J
authors.lastname: Meira
authors.forename: Armando
authors.initials: A
authors.lastname: Mansilha
authors.forename: José A
authors.initials: JA
authors.lastname: Paiva
authors.forename: Roncon
authors.initials: R
authors.lastname: de Albuquerque
mesh_terms: D000151:Acinetobacter Infections / Q000150:complications* / Q000188:drug therapy; D040981:Acinetobacter baumannii; D000328:Adult; D001916:Brachial Artery / Q000293:injuries* / Q000601:surgery*; D024901:Drug Resistance, Multiple, Bacterial; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000382:microbiology*; D011552:Pseudomonas Infections / Q000150:complications* / Q000188:drug therapy; D012422:Rupture, Spontaneous; D012501:Saphenous Vein / Q000637:transplantation*