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Published in: Journal of Medical Case Reports 1/2013

Open Access 01-12-2013 | Case report

Femoral vein obturator bypass revascularization in groin infectious bleeding: two case reports and review of the literature

Published in: Journal of Medical Case Reports | Issue 1/2013

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Abstract

Introduction

Groin infections resulting in arterial bleeding due to bacterial vessel destruction are a severe challenge in vascular surgery. Patients with them most often present as emergencies and therefore need individualized reconstruction solutions.

Case presentation

Case 1 is a 67-year-old man with infectious bleeding after an autologous reconstruction of the femoral bifurcation with greater saphenous vein due to infection of a bovine pericard patch after thrombendarterectomy. Case 2 is a 35-year-old male drug addict and had severe femoral bleeding and infection after repeated intravenous and intra-arterial substance abuse. Both patients were treated with an autologous obturator bypass of the superficial femoral vein. We review the current literature and highlight our therapeutic concept of this clinical entity.

Conclusions

Treatment should include systemic antibiotic medication, surgical control of the infectious site, revascularization and soft tissue repair. An extra-anatomical obturator bypass with autologous superficial femoral vein should be considered as the safest revascularization procedure in infections caused by highly pathogenic bacteria.
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Literature
1.
go back to reference Matoussevitch V, Aleksic M, Gawenda M, Brunkwall J: Primary extraanatomical revascularization for groin infections in drug addicts. Vasa. 2007, 36: 210-214. 10.1024/0301-1526.36.3.210.CrossRefPubMed Matoussevitch V, Aleksic M, Gawenda M, Brunkwall J: Primary extraanatomical revascularization for groin infections in drug addicts. Vasa. 2007, 36: 210-214. 10.1024/0301-1526.36.3.210.CrossRefPubMed
2.
go back to reference Zetrenne E, McIntosh BC, McRae MH, Gusberg R, Evans GR, Narayan D: Prosthetic vascular graft infection: a multi-center review of surgical management. Yale J Biol Med. 2007, 80: 113-121.PubMed Zetrenne E, McIntosh BC, McRae MH, Gusberg R, Evans GR, Narayan D: Prosthetic vascular graft infection: a multi-center review of surgical management. Yale J Biol Med. 2007, 80: 113-121.PubMed
3.
go back to reference Meyer T, Schweiger H, Lang W: Extraanatomic bypass in the treatment of prosthetic vascular graft infection manifesting in the groin. Vasa. 1999, 28: 283-288. 10.1024/0301-1526.28.4.283.CrossRefPubMed Meyer T, Schweiger H, Lang W: Extraanatomic bypass in the treatment of prosthetic vascular graft infection manifesting in the groin. Vasa. 1999, 28: 283-288. 10.1024/0301-1526.28.4.283.CrossRefPubMed
4.
go back to reference Engin C, Posacioglu H, Ayik F, Apaydin AZ: Management of vascular infection in the groin. Tex Heart Inst J. 2005, 32: 529-534.PubMedPubMedCentral Engin C, Posacioglu H, Ayik F, Apaydin AZ: Management of vascular infection in the groin. Tex Heart Inst J. 2005, 32: 529-534.PubMedPubMedCentral
5.
go back to reference Scheuerlein H, Ruff S, Haage P, Zirngibl H, Fraunhofer S, Settmacher U: Groin abscesses and vascular catastrophes in intravenous drug users: strategy and results [in German]. Zentralbl Chir. 2008, 133: 55-60. 10.1055/s-2008-1004658.CrossRefPubMed Scheuerlein H, Ruff S, Haage P, Zirngibl H, Fraunhofer S, Settmacher U: Groin abscesses and vascular catastrophes in intravenous drug users: strategy and results [in German]. Zentralbl Chir. 2008, 133: 55-60. 10.1055/s-2008-1004658.CrossRefPubMed
6.
go back to reference Naqi SA, Khan HM, Akhtar S, Shah TA: Femoral pseudoaneurysm in drug addicts: excision without revascularization is a viable option. Eur J Vasc Endovasc Surg. 2006, 31: 585-587. 10.1016/j.ejvs.2005.12.011.CrossRefPubMed Naqi SA, Khan HM, Akhtar S, Shah TA: Femoral pseudoaneurysm in drug addicts: excision without revascularization is a viable option. Eur J Vasc Endovasc Surg. 2006, 31: 585-587. 10.1016/j.ejvs.2005.12.011.CrossRefPubMed
7.
go back to reference Georgiadis GS, Lazarides MK, Polychronidis A, Simopoulos C: Surgical treatment of femoral artery infected false aneurysms in drug abusers. ANZ J Surg. 2005, 75: 1005-1010. 10.1111/j.1445-2197.2005.03578.x.CrossRefPubMed Georgiadis GS, Lazarides MK, Polychronidis A, Simopoulos C: Surgical treatment of femoral artery infected false aneurysms in drug abusers. ANZ J Surg. 2005, 75: 1005-1010. 10.1111/j.1445-2197.2005.03578.x.CrossRefPubMed
8.
go back to reference Mayer D, Hasse B, Koelliker J, Enzler M, Veith FJ, Rancic Z, Lachat M: Long-term results of vascular graft and artery preserving treatment with negative pressure wound therapy in Szilagyi grade III infections justify a paradigm shift. Ann Surg. 2011, 254: 754-759. 10.1097/SLA.0b013e3182365864.CrossRefPubMed Mayer D, Hasse B, Koelliker J, Enzler M, Veith FJ, Rancic Z, Lachat M: Long-term results of vascular graft and artery preserving treatment with negative pressure wound therapy in Szilagyi grade III infections justify a paradigm shift. Ann Surg. 2011, 254: 754-759. 10.1097/SLA.0b013e3182365864.CrossRefPubMed
9.
go back to reference Ferreira U, Reis LO, Ikari LY, da Silva W, Matheus WE, Denardi F, Stopiglia RM, Menezes FH: Extraanatomical transobturator bypass graft for femoral artery involvement by metastatic carcinoma of the penis: report of five patients. World J Urol. 2008, 26: 487-491. 10.1007/s00345-008-0282-z.CrossRefPubMed Ferreira U, Reis LO, Ikari LY, da Silva W, Matheus WE, Denardi F, Stopiglia RM, Menezes FH: Extraanatomical transobturator bypass graft for femoral artery involvement by metastatic carcinoma of the penis: report of five patients. World J Urol. 2008, 26: 487-491. 10.1007/s00345-008-0282-z.CrossRefPubMed
10.
go back to reference Patel A, Taylor SM, Langan EM, Snyder BA, Cull DL, Sullivan TM, Youkey JR, Gray BH, Carsten CG: Obturator bypass: a classic approach for the treatment of contemporary groin infection. Am Surg. 2002, 68: 653-658.PubMed Patel A, Taylor SM, Langan EM, Snyder BA, Cull DL, Sullivan TM, Youkey JR, Gray BH, Carsten CG: Obturator bypass: a classic approach for the treatment of contemporary groin infection. Am Surg. 2002, 68: 653-658.PubMed
11.
go back to reference Sautner T, Niederle B, Herbst F, Kretschmer G, Polterauer P, Rendl KH, Prenner K: The value of obturator canal bypass: a review. Arch Surg. 1994, 129: 718-722. 10.1001/archsurg.1994.01420310050008.CrossRefPubMed Sautner T, Niederle B, Herbst F, Kretschmer G, Polterauer P, Rendl KH, Prenner K: The value of obturator canal bypass: a review. Arch Surg. 1994, 129: 718-722. 10.1001/archsurg.1994.01420310050008.CrossRefPubMed
12.
go back to reference Nevelsteen A, Lacroix H, Suy R: Autogenous reconstruction with the lower extremity deep veins: an alternative treatment of prosthetic infection after reconstructive surgery for aortoiliac disease. J Vasc Surg. 1995, 22: 129-134. 10.1016/S0741-5214(95)70106-0.CrossRefPubMed Nevelsteen A, Lacroix H, Suy R: Autogenous reconstruction with the lower extremity deep veins: an alternative treatment of prosthetic infection after reconstructive surgery for aortoiliac disease. J Vasc Surg. 1995, 22: 129-134. 10.1016/S0741-5214(95)70106-0.CrossRefPubMed
13.
go back to reference Schulman ML, Badhey MR, Yatco R, Pillari G: A saphenous alternative: preferential use of superficial femoral and popliteal veins as femoropopliteal bypass grafts. Am J Surg. 1986, 152: 231-237. 10.1016/0002-9610(86)90248-5.CrossRefPubMed Schulman ML, Badhey MR, Yatco R, Pillari G: A saphenous alternative: preferential use of superficial femoral and popliteal veins as femoropopliteal bypass grafts. Am J Surg. 1986, 152: 231-237. 10.1016/0002-9610(86)90248-5.CrossRefPubMed
14.
go back to reference Biró G, Szeberin Z, Nemes A, Acsády G: Cryopreserved homograft and autologous deep vein replacement for infrarenal aorto and iliaco-femoral graft infection: early and late results. J Cardiovasc Surg (Torino). 2011, 52: 169-176. Biró G, Szeberin Z, Nemes A, Acsády G: Cryopreserved homograft and autologous deep vein replacement for infrarenal aorto and iliaco-femoral graft infection: early and late results. J Cardiovasc Surg (Torino). 2011, 52: 169-176.
15.
go back to reference Lorenz U, Schafer T, Ohlsen K, Tiurbe GC, Buhler C, Germer CT, Kellersmann R: In vivo detection of Staphylococcus aureus in biofilm on vascular prostheses using non-invasive biophotonic imaging. Eur J Vasc Endovasc Surg. 2011, 41: 68-75. 10.1016/j.ejvs.2010.09.007.CrossRefPubMed Lorenz U, Schafer T, Ohlsen K, Tiurbe GC, Buhler C, Germer CT, Kellersmann R: In vivo detection of Staphylococcus aureus in biofilm on vascular prostheses using non-invasive biophotonic imaging. Eur J Vasc Endovasc Surg. 2011, 41: 68-75. 10.1016/j.ejvs.2010.09.007.CrossRefPubMed
16.
go back to reference Benjamin ME, Cohn EJ, Purtill WA, Hanna DJ, Lilly MP, Flinn WR: Arterial reconstruction with deep leg veins for the treatment of mycotic aneurysms. J Vasc Surg. 1999, 30: 1004-1015. 10.1016/S0741-5214(99)70038-8.CrossRefPubMed Benjamin ME, Cohn EJ, Purtill WA, Hanna DJ, Lilly MP, Flinn WR: Arterial reconstruction with deep leg veins for the treatment of mycotic aneurysms. J Vasc Surg. 1999, 30: 1004-1015. 10.1016/S0741-5214(99)70038-8.CrossRefPubMed
17.
go back to reference Murphy GJ, Pararajasingam R, Nasim A, Dennis MJ, Sayers RD: Methicillin-resistant Staphylococcus aureus infection in vascular surgical patients. Ann R Coll Surg Engl. 2001, 83: 158-163.PubMedPubMedCentral Murphy GJ, Pararajasingam R, Nasim A, Dennis MJ, Sayers RD: Methicillin-resistant Staphylococcus aureus infection in vascular surgical patients. Ann R Coll Surg Engl. 2001, 83: 158-163.PubMedPubMedCentral
Metadata
Title
Femoral vein obturator bypass revascularization in groin infectious bleeding: two case reports and review of the literature
Publication date
01-12-2013
Published in
Journal of Medical Case Reports / Issue 1/2013
Electronic ISSN: 1752-1947
DOI
https://doi.org/10.1186/1752-1947-7-75

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