Abstract: Journal of Medical Images and Medical Education Research

Abstract:
Aortobifemoral bypass (ABF) grafting is an effective procedure for managing severe aortoiliac occlusive dis ease. Among the multiple potential postoperative complications, some of the most feared and complex in its management are vascular graft infections (VGI). The use of synthetic material for reconstructive vascular surgery was first reported during the early 1950s, and infections of these grafts were associated with high mor bidity and potential mortality. More recently, the incidence of VGI varies on the graft location. Extracavitary grafts carry a 1.5% to 2% infection rate, and up to 6% in those implanted in the groin. Similarly, intracavitary grafts carry between a 1% to 5% infection rate [1,4,5]. Though improvements in graft design and surgical technique have reduced VGI frequency and severity, they remain a serious complication. Sequelae of VGI can include fulminant bacteremia and sepsis as well as fistula formation. Here, we focus on the aorta ureteral f istula (AUF) after the open aortobifemoral bypass. AUF is of particular interest to practitioners because of a sometimes-indolent course and delayed diagnosis, leading to catastrophic outcomes [3]. AUF diagnostic difficulty is compounded as conventional radiographic tests are often unsuccessful in identifying the fistulas resulting from graft infections. Clinical findings may therefore best alert physicians to AUFs, like the presence of gross haematuria [2]. Historically, Staphylococcus Aureus was a predominant pathogen in VGI and result ing AUF. However, advances in surgical techniques, changes in patient demographics and hospital flora have led to a diverse range of causal pathogens. Treatment requires collaboration between vascular surgery and infectious disease teams when managing complex VGIs. This case report details a challenging instance of VGI and associated AUF in a patient with a complex medical history.