Non-anastomotic midgraft stenosis of a knitted Dacron graft after repeat arterial reconstruction - Report of a case

Midgraft stenosis of the prosthesis after bypass surgery has seldom been reported. A man presented with an ischemic ulcer of the left foot. He had undergone bilateral femoropopliteal bypass surgery as well as left-sided iliofemoral bypass surgery with a knitted Dacron graft. The graft in his left thigh was occluded. A knitted Dacron conduit with 8-mm. diameter was interposed between the iliofemoral bypass graft and the left profunda femoris artery, and graft-popliteal jumping bypass surgery was added. The postoperative angiogram showed a short-segmental severe stenosis of the interposed graft neighboring the proximal anastomosis. Repeat surgery showed that the stenotic lesion was located separately from the anastomosis. This midgraft stenosis was considered to consist of dissection of pseudointima associated with the intraoperative procedures. In cases of repeat surgery around the inguinal ligament, procedures should be performed with great care.