Paneled saphenous vein graft repair of an iliac artery injury in a contaminated abdomen: Late complication of aneurysmal degeneration illustrating the need for continued surveillance.
Schwarcz T, Nypaver T. Paneled saphenous vein graft repair of an iliac artery injury in a contaminated abdomen: Late complication of aneurysmal degeneration illustrating the need for continued surveillance.. J Vasc Access 2017; 66(2):E38-E39.
J Vasc Access
The management of acute intra-abdominal arterial injury (AIAAI) in the setting of enteric contamination is challenging. When the AIAAI extensive enough to preclude primary repair, the choice of conduit in the arterial reconstruction becomes critical. Use of in-line prosthetic grafts exposes the patient to the devastating possibility of subsequent graft infection, while extra-anatomic bypasses have limited durability as well as residual infection risk. Autogenous options in the emergency setting are limited and complicated by size mismatch. Paneled saphenous vein grafts (PSVG) accommodate the size discrepancy; however, longterm outcomes are essentially unknown. This case describes a 23-year follow-up of a PSVG iliac artery repair inclusive of operative management of late aneurysmal graft degeneration. A 17-year-old girl was transferred to a Level I trauma center after an attempted laparoscopic appendectomy that resulted in trocar placement into the right common iliac artery and vein. Before transfer, the iliac vein was oversewn and an arterial repair performed with a Dacron graft. The patient presented with hypotension and a severely ischemic right lower extremity. She underwent emergency abdominal exploration, and findings included previously unrecognized small bowel enterotomies. The Dacron graft was excised, and a PSVG was used as an interposition iliac artery graft. The patient experienced a very complicated 3-week hospitalization, but the end result was that of a viable, functional, normally perfused extremity. The patient presented 13 years later at another hospital with acute abdominal pain. An abdominal computed tomography scan demonstrated a hernia and a 2.5-cm right common iliac artery aneurysm (Fig 1). The right common iliac artery PSVG aneurysm was replaced with an interposition femoral vein harvested from the left lower extremity (Fig 2). The postoperative course was complicated by distal left lower extremity deep venous thrombosis. Over the subsequent 10 years, follow-up surveillance has demonstrated modest dilatation of the femoral vein graft, which remains intact and patent. This case illustrates the need for continuous surveillance of patients who have undergone intra-abdominal vein graft repair, particularly those with paneled or spiral grafts.