Case Report: Vascular Graft Infection Presenting 40 Years After Index Operation

Author(s):
Amani Politano; Erica Mitchell

Background:

Background: Vascular graft infections can be challenging to manage. Degree of prosthetic involvement, options for reconstruction, bacterial speciation with the need for long-term antibiotics, and associated morbidity are all considerations for vascular surgeons treating patients who present with graft infections.

Methods:

Method: We present a case report of a chest wall graft infection occurring forty years after the index operation, including the diagnosis, revascularization, and etiology of the infection.

Results:

Results: A 73 year-old immunosuppressed, oxygen-dependent woman presented to our clinic with concern for exposed chest wall graft material. Her history was significant for a gunshot wound to the right chest forty years prior with resultant arterial injury, for which she underwent repair via a left-subclavian-to-right-axillary-artery bypass with woven graft. At the time of her presentation, her physical exam demonstrated a mid-sternal wound with exposed graft material. Treatment of the graft infection consisted of a right-carotid-to-right-brachial-artery bypass utilizing cryopreserved great saphenous vein with near total removal of the existing graft material. Intra-operative gram stain of the wound and graft was negative, therefore the tissue was debrided, irrigated with antibiotics, and covered with a wound vac. Post-operative cultures grew Listeria monocytogenes requiring removal of all graft material for treatment cure. This required right axillary artery ligation and left subclavian artery vein patch angioplasty. She received intravenous antibiotics for six weeks post-operatively and wound vac management of the sternal wound.

Conclusions:

Conclusion: We present a case of an extra-anatomic chest wall vascular graft infection successfully treated with cryovein bypass and graft excision. This case is unique in the nature of the infection, the longevity of the index bypass, and the initially negative intraoperative cultures that guided the initial and subsequent treatment paradigm.