title: [Dilemmas of the reconstruction of the major pelvic artery due to infectious aortic graft complication].
abstract: BACKGROUND
  In the pelvic region thrombendarterectomy and bypass procedures are the most commonly performed procedures to treat peripheral artery occlusive diseases with chronic, severe circulation failure caused by atherosclerosis. Biologic and synthetic grafts can also be used in bypass surgeries. Application of synthetic grafts can acutely increase the development of the infectious graft complication and its mortality is still between 70 and 75% in pelvic processes. We describe the difficulties and dilemmas of an infectious aortobifemoral graft.
  
  
  METHODS
  58-year-old female patient with right lower limb trophic ulcer underwent a DSA examination showing a bilateral iliac occlusion and aortobifemoral bypass surgery with Dacron graft implantation was performed. Re-occlusion and infection of the graft led to an in situ silver Dacron graft replacement. Due to the one-sided re-occlusion, a femoro-femoral crossover bypass surgery applying silver graft was performed. Despite the previously described procedures the infectious process got worse and autologous deep vein reconstruction was required beside the removal of the infectious synthetic grafts at the same time.
  
  
  CONCLUSIONS
  There are local and extraanatomical solutions to reduce infectious graft complication. In pelvic infections bypass surgeries using autologous deep vein can show the best results. This procedure is the trustworthiest but also the most straining technique due to the extension of surgical time and increased blood loss. The proper surgical strategy should be selected on individual bases including cardiopulmonary load ability, patient age and technical/infrastructural possibilities.
authors.affiliation: Pécsi Tudományegyetem Általános Orvostudományi Kar Érsebészeti Klinika 7623 Pécs Rákóczi út 2. Pf. 172.
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authors.lastname: Szelechman
authors.affiliation: Pécsi Tudományegyetem Általános Orvostudományi Kar Érsebészeti Klinika 7623 Pécs Rákóczi út 2. Pf. 172.
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authors.affiliation: Pécsi Tudományegyetem Általános Orvostudományi Kar Érsebészeti Klinika 7623 Pécs Rákóczi út 2. Pf. 172.
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authors.affiliation: Pécsi Tudományegyetem Általános Orvostudományi Kar Érsebészeti Klinika 7623 Pécs Rákóczi út 2. Pf. 172.
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authors.affiliation: Pécsi Tudományegyetem Általános Orvostudományi Kar Érsebészeti Klinika 7623 Pécs Rákóczi út 2. Pf. 172.
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authors.affiliation: Pécsi Tudományegyetem Általános Orvostudományi Kar Érsebészeti Klinika 7623 Pécs Rákóczi út 2. Pf. 172.
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authors.affiliation: Pécsi Tudományegyetem Általános Orvostudományi Kar Érsebészeti Klinika 7623 Pécs Rákóczi út 2. Pf. 172.
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authors.lastname: Hardi
authors.affiliation: Pécsi Tudományegyetem Általános Orvostudományi Kar Érsebészeti Klinika 7623 Pécs Rákóczi út 2. Pf. 172.
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authors.forename: László
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authors.lastname: Benkő
authors.affiliation: Pécsi Tudományegyetem Általános Orvostudományi Kar Érsebészeti Klinika 7623 Pécs Rákóczi út 2. Pf. 172.
authors.forename: Melinda
authors.initials: M
authors.lastname: Gadácsi
authors.affiliation: Pécsi Tudományegyetem Általános Orvostudományi Kar Érsebészeti Klinika 7623 Pécs Rákóczi út 2. Pf. 172.
authors.forename: Nikoletta
authors.initials: N
authors.lastname: Lima
authors.affiliation: Pécsi Tudományegyetem Általános Orvostudományi Kar Érsebészeti Klinika 7623 Pécs Rákóczi út 2. Pf. 172.
authors.forename: Gábor
authors.initials: G
authors.lastname: Menyhei
authors.affiliation: Pécsi Tudományegyetem Általános Orvostudományi Kar Érsebészeti Klinika 7623 Pécs Rákóczi út 2. Pf. 172.
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keywords: aortobifemoral bypass procedure; aortobifemoralis bypass; autologous deep vein reconstructiony; autológ mélyvéna-áthidalás; prosthetic graft infection; silver graft; szeptikus graft