Journal of Angiology & Vascular Surgery Category: Medical Type: Case Report
Trans Obturator Ilio-Femoral Bypass in Case of Ruptured Left Common Femoral Artery Pseudoaneurysm
- Amr Abdelghaffar Mahmoud1*, Amr Nabil Kamel2
- 1 Specialist And Assistant Lecturer Of Vascular Surgery, Ain Shams University, Cairo, Egypt
- 2 Consultant Lecturer Of Vascular Surgery, Ain Shams University, Cairo, Egypt
*Corresponding Author:Amr Abdelghaffar Mahmoud
Specialist And Assistant Lecturer Of Vascular Surgery, Ain Shams University, Cairo, Egypt
Received Date: Feb 09, 2018 Accepted Date: Apr 16, 2018 Published Date: Apr 30, 2018
SUBJECTS AND METHOD
• First day postoperatively, patient developed left Lower Limb (LL) acute ischemia Rutherford stage II b in the form of absent distal pulsation, absent Dopplersignals, decrease motor power and coldness
• She received urgent operation in the form of trans-obturator ilio-femoral bypass (between EIA proximal to ligation site and distal to SFA) (Figure 1)
• Type of bypass is synthetic bypass using 8 mm ringed Polytetrafluoroethylene (PTFE) graft
• The tunnel was fashioned in a plane deep to the adductor muscles to be rather away from the infected areas without need of leg fasciotomy
• The infection was deep seated at left groin with affection skin, subcutaneous tissue and femoral vessel with subsequent pseudoaneurysm at CFA. Muscles of medical compartment and anterior compartment of thigh are viable with no need for muscle debridement
Figure 1: Iliac anastomosis and femoral anastomosis using PTFE graft 8 mm.
Aim of study
|Bladder perforation |
|Bypass misplacement (vaginal transgression) |
|Injury to neurovascular bundle |
|Rectal perforation |
|Graft infection1 |
|Occlusion (early and late) |
|Muscle necrosis |
|False aneurysm of graft1 |
|Recurrent hemorrhage secondary to persistent Infection |
The graft is still patent for the 6 months follow up (Ultrasound is the tool for follow up).
The procedure should not be omitted from the armamentarium of any vascular surgeon.
- Sautner T, Niederle B, Herbst F, Kretschmer G, Polterauer P, et al. (1994) The value of obturator canal bypass. A review. Arch Surg 129: 718-722.
- Fromm SH, Lucas CE (1970) Obturator bypass for mycotic aneurysm in the drug addict. Arch Surg 100: 82-83.
- Guida PM, Moore SW (1969) Obturator bypass technique. Surg Gynecol Obstet 128: 1307-1316.
- Rabbani A, Moini M, Rasouli MR (2008) Obturator bypass as an alternative technique for revascularization in patients with infected femoral pseudoaneurysms. Arch Iran Med 11: 50-53.
- Salehian MT, Shahid N, Mohseni M, Ghodoosi I, Marashi SA, et al. (2006) Treatment of infected pseudoaneurysm in drug abusers: Ligation or reconstruction? Arch Iran Med 9: 49-52.
- Ruangsetakit C, Chinsakchai K, Hahtapornsawan S, Wongwanit C, Sermsathanasawadi N, et al. (2012) Successful outcome of obturator bypass surgery in infected femoral pseudoaneurysm: Three cases report and literature review. J Med Assoc Thai 95: 470-475.
- Pearce WH, Ricco JB, Yao JS, Flinn WR, Bergan JJ (1983) Modified technique of obturator bypass in failed or infected grafts. Ann Surg 197: 344-347.
- Van Det RJ, Brands LC (1981) The obturator foramen bypass: An alternative procedure in iliofemoral artery revascularization. Surgery 89: 543-547.
- Sheiner NM, Sigman H, Stilman A (1969) An unusual complication of obturator foramen arterial bypass. J Cardiovasc Surg (Torino) 10: 324-328.
- Prenner KV, Rendl KG (1982) Indications and technique for obturator bypass. In: Greenhalgh RM, (ed). Extra-anatomic and secondary arterial reconstruction. Pitman Books, London, pg no: 406.
- Geroulakos G, Parvin SD, Bell PR (1988) Obturator foramen bypass--the alternative route for sepsis in the femoral triangle. Acta Chir Scand 154: 111-112.
Citation:Mahmoud AA, Kamel AN (2018) Trans Obturator Ilio-Femoral Bypass in Case of Ruptured Left Common Femoral Artery Pseudoaneurysm. J Angiol Vasc Surg 3: 014.
Copyright: © 2018 Amr Abdelghaffar Mahmoud, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.