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Arterial surgery by nature is associated with many complications some of which may may require further surgery to correct. Here are some examples of situations requiring re-do surgery.
In relation to the time of surgery, graft failure can be immediate, intermediate or late. The main causes for immediate graft failure are abnormal blood clotting and technical problems with the surgery. Whilst exploratory surgery can identify and correct technical causes of failure, it is of limited value if failure is due to clotting disorders.
Intermediate and late graft failure can benefit from surgery either to restore the graft or replace it.
Re-do surgery in all these situations is technically very demanding and carry an even higher risk of complications than the original procedure.
This is a serious complication particularly when a synthetic graft is involved. Synthetic graft infection can occur at any time after surgery. Once infected, it is almost impossible to completely clear the graft from infection. Long term antibiotic treatment may contain the infection for reasonably long periods of time.
Graft infection can present in various forms. Some patients will complain of general and none specific feeling of ill being. Sporadic episodes of rigors, night sweats and fever may occur. Locally, abscess or false aneurysm formation may present as a lump at the site of surgery. A discharging sinus may also form.
Surgery to remove the infected graft sometimes becomes the only solution to eradicate the infection. A replacement bypass may not be possible due to the infection, making the risk of limb loss in these patients very high.
False aneurysms develop when injury, infection, or injury and infection cause localised weakness in the arterial wall. The arterial blood pressure develops this weakness into a false aneurysm. These aneurysms develop rapidly and are certain to rupture if untreated. |
Graft infection. A large collection of pus is seen along the course of the graft "on the inside of the leg". There is a discharging sinus at the lower end Y the collection.
This patient had an emergency exploration of the common femoral artery. The wound became infected and six weeks later, the patient re-presented with the shown ruptured false aneurysm.
The same patient as above. The suture line from the previous surgery together with a good part of the arterial wall have disintegrated completely.
The defect was successfully repaired with a vein patch. |
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