Traumatic Fracture of Polytetrafluoroethylene Axillofemoral Bypass Graft

Kitowski, Nicholas J.; Gundersen, Sigurd B.

doi:10.1177/1538574409352691

Cited by 5 publications

(4 citation statements)

References 6 publications

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“…A flexible plastic tube is placed to divert blood from the axillary artery directly to the femoral arteries, bypassing the areas of blockage. This procedure is indicated for patients with peripheral vascular disease, aortoiliac occlusive disease, or infectious artery disease [ 11 , 12 ]. In a comparative study, Passman et al examined the morbidity, mortality, and patency rates for aortofemoral bypass grafting and BiFAXB grafting.…”

Section: Discussionmentioning

confidence: 99%

Atraumatic Bi-femoral Axillary Bypass Graft Non-anastomotic Disruption With Pseudoaneurysm Formation Detected by Doppler Ultrasound

Nesbit¹,

Wang²,

Grenz³

et al. 2022

Cureus

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Bi-femoral axillary bypass graft placement is a well-known and typically safe procedure. It is generally indicated for patients with advanced peripheral vascular disease, aortoiliac occlusive disease, or infectious artery disease. In rare cases, the graft can be fractured or dislodged after placement, though most often, this occurs almost exclusively at the anastomosis site, secondary to blunt trauma. Using ultrasonic imaging is a reliable method of detecting these fractures. We present a case of a bi-femoral axillary bypass graft fracture in a 68-year-old male with the development of a pseudoaneurysm in the right lateral abdominal wall. The patient reported spontaneous development of a "strange" sensation in his right lower abdomen and a "painful lump" upon waking. Physical examination showed a small right lower quadrant outpouching which was pulsatile on palpation. The initial workup included a bedside ultrasound which showed a fractured graft with the fluid collection and a Doppler signal. Vascular surgery was immediately consulted for evaluation, and the patient was taken to the operating room for emergent surgical repair. CT angiography confirmed a successful operation in which an 8 mm graft was placed to anastomose the original bypass graft fracture site. The patient remained stable postoperatively and was discharged without further complications. This report highlights the importance of using ultrasonography for the immediate identification of potential graft complications to prevent serious complications and expedite definitive management.

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Section: Discussionmentioning

confidence: 99%

Atraumatic Bi-femoral Axillary Bypass Graft Non-anastomotic Disruption With Pseudoaneurysm Formation Detected by Doppler Ultrasound

Nesbit¹,

Wang²,

Grenz³

et al. 2022

Cureus

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“…The incidence of graft ruptures is around 5% [11]. There are limited number of studies reporting axillo-femoral graft ruptures and distortions [9][10][11][12][13][14][15]. PTFE graft rupture and development of pseudoaneurysm are rare complications in vascular surgery.…”

Section: Discussionmentioning

confidence: 99%

Acute prosthetic vascular graft distortion in the subclavian region: A case report and a review of the literature

Kahraman¹,

Taner²,

Gürsoy³

et al. 2019

Journal of Surgery and Medicine

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This is an open access article distributed under the terms of the CreativeCommons Attribution-Non Commercial-NoDerivatives License 4.0 (CC BY-NC-ND 4.0) where it is permissible to download, share, remix, transform, and buildup the work provided it is properly cited. The work cannot be used commercially without permission from the journal. AbstractA 68-year-old male patient was admitted to the emergency department with complaints of sudden swelling under his right clavicle. He had undergone right axillo-femoral and femoro-femoral crossover bypasses 1.5 months ago due to peripheral artery disease. The subclavicular swelling had started one day ago. Physical examination revealed a pulsatile mass expanding from under the right clavicle towards the right breast. In auscultation, a murmur was heard on the mass and the patient was hospitalized with a diagnosis of pseudoaneurysm. Doppler ultrasonography revealed a 10x10 cm pseudoaneurysm sac in the right subclavian area. Hemoglobin level had decreased to 5.9 mg/dL. 2 units of erythrocyte suspension was transfused, after which the patient was operated emergently. During the operation, hemorrhage from the proximal and distal subclavian arteries was controlled with a fogarty catheter advanced to the subclavian artery via the brachial artery and axillo femoral graft. When the pseudo-aneurysm sac was incised, the synthetic vascular graft between the right axillary and right femoral arteries was observed to have dislocated distal to the axillary anastomosis area by approximately 1 cm. A new graft interposition was performed after resecting the torn synthetic graft section. The patient was discharged after an uneventful postoperative period.Öz 68 yaşında erkek hasta sağ klavikula altında ani başlayan şişlik ile acil servise başvurdu. Anamnezinde hastaya periferik arter hastalığı nedeniyle 1,5 ay önce sağ aksillo-femoral ve femoro-femoral crossover bypass yapıldığı öğrenildi. Subkavikular bölgede kolun aşırı yukarı ve geriye doğru gerilme hareketi sonrası aniden başlayan ve giderek artış gösteren şişliği vardı. Fizik muayenede sağ klavikula altından başlayan koltuk altına ve sağ memeye doğru yayılım gösteren pulsatile kitle tespit edildi. Oskültasyonda kitle üzerinde üfürüm duyuldu ve pseudoanevrizma ön tanısıyla yatırıldı. Acil şartlarda damar cerrahı tarafından yatak başı yapılan Doppler Ultrasonografide subklavian bölgedeki şişliğin pseudoanevrizma kesesi olduğu ve yaklaşık boyutunun 10x10 cm olduğu tespit edildi. Acil rutin kan tetkiklerinde Hemoglobin seviyesi 5,9'e kadar düşmüştü. Bunun üzerine acil kan hazırlığının ardından 2 ünite eritrosit süspansiyonu verildikten sonra acil operasyona alındı. Hastanın proximal ve distal subklavian arterdeki kanama kontrolü brakial arter ve aksillo-femoral greft yoluyla subklavian artere gönderilen fogarty kateteri ile sağlandı. Pseudoanevrizma kesesi açıldığı zaman sağ aksiller arter ile sağ femoral arter arasındaki sentetik vasküler greftin aksiller anastomoz alanına yaklaşık 1 cm mesafeden ayrılmış olduğu görüldü. Yırtılmış olan sent...

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“…Apart from several case reports of disrupted bypasses without proven trauma history, 3 authors reported pseudoaneurysms in nonanastomotic regions of an axillofemoral graft because of preceding trauma [2] , [3] . The patients were treated either with an interposition graft.…”

Section: Discussionmentioning

confidence: 99%

“…We are presenting a patient sustaining a complete rupture of a polytetrafluoroethylene (PTFE) axilloprofundal bypass in his thoracic midportion after proven blunt trauma. Until now, only 3 authors have reported similar cases [2] , [3] , [4] .…”

Section: Introductionmentioning

confidence: 99%

Traumatic nonanastomotic axilloprofundal PTFE-bypass rupture: a case report

Barth

Hässler

Graubitz

2017

Radiology Case Reports

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A 76-year-old male patient was admitted to our emergency department with painful swelling of the right lateral chest after a fall. Imaging revealed a hematoma, secondary to rupture of a synthetic axilloprofundal bypass. In an emergency surgical procedure, the spelled hematoma was evacuated and the graft legs were successfully ligated. The patient was discharged after an uneventful hospital stay. Traumatic bypass rupture because of blunt trauma is an exceedingly rare event; however, it must be taken into consideration in a patient with bypass surgery in his/her history.

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Traumatic Fracture of Polytetrafluoroethylene Axillofemoral Bypass Graft

Cited by 5 publications

References 6 publications

Atraumatic Bi-femoral Axillary Bypass Graft Non-anastomotic Disruption With Pseudoaneurysm Formation Detected by Doppler Ultrasound

Atraumatic Bi-femoral Axillary Bypass Graft Non-anastomotic Disruption With Pseudoaneurysm Formation Detected by Doppler Ultrasound

Acute prosthetic vascular graft distortion in the subclavian region: A case report and a review of the literature

Traumatic nonanastomotic axilloprofundal PTFE-bypass rupture: a case report

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