Aortobifemoral prothesis infection

IntroductionVascular prosthesis infection constitutes one of the most serious complications in vascular surgery and is associated with a high risk of extremity amputation or death. Possibilities of conservative treatment are limited. The only radical procedure effecting the regression of inflammation is the removal of the infected prosthesis. This usually necessitates vascular reconstruction in the involved extremities. An ideal way to reconstruct blood flow in the lower extremities does not exist.AimThis work aimed at presenting possibilities for managing complications in a patient with an aortobifemoral prosthesis.Case studyThe described patient developed symptoms of intermittent claudication at the age of 38 years. When he was 39 years old he had a myocardial infarction, and afterwards problems concerning his lower extremities exacerbated. This necessitated the implantation of aortobifemoral prosthesis. After 5 years, the patient was operated on due to an anastomotic pseudoaneurysm in the left groin area, and then due to hemorrhage from the anastomotic pseudoaneurysm in the right groin area with symptoms of prosthesis infection. In January 2000, the infected prosthesis was removed surgically and a bypass polytetrafluoroethylene (PTFE) graft to both femoral arteries was implanted with a good result. In 2005, the patient was operated on due to a cerebral aneurysm.Results and discussionThe bypass graft has been functional in the described patient for 11 years, despite progressive atherosclerosis, smoking, three surgeries due to a graft thrombosis and an anastomotic pseudoaneurysm.ConclusionsDespite the enumerated complications and progressive atherosclerosis, the patient did not manage to give up his addiction (smoking). His case illustrates various difficulties in the course of treating an infected prosthesis, even when bacteria are very sensitive to antibiotics.