Endovascular recanalization of the superior mesenteric artery in the context of mesenteric bypass graft infection

• Published in: Journal of vascular surgery Vol. 57; no. 5; pp. 1398 - 1400
• Main Authors: Johnston, Paul C., MD, Guercio, Aaron F., MD, Johnson, Stephen P., MD, Hollis, H. Whitton, MD, Pratt, Charles F., MD, Rehring, Thomas F., MD
• Format: Journal Article
• Language: English
• Published: United States Mosby, Inc 01-05-2013
• Subjects: Abdominal Pain - etiology; Blood Vessel Prosthesis - adverse effects; Blood Vessel Prosthesis Implantation - adverse effects; Blood Vessel Prosthesis Implantation - instrumentation; Device Removal; Duodenal Diseases - etiology; Duodenal Diseases - surgery; Endovascular Procedures; Graft Occlusion, Vascular - diagnosis; Graft Occlusion, Vascular - etiology; Graft Occlusion, Vascular - surgery; Humans; Intestinal Fistula - etiology; Intestinal Fistula - surgery; Intestinal Perforation - etiology; Intestinal Perforation - surgery; Ischemia - surgery; Male; Mesenteric Artery, Superior - surgery; Mesenteric Ischemia; Mesenteric Vascular Occlusion - surgery; Middle Aged; Prosthesis-Related Infections - diagnosis; Prosthesis-Related Infections - microbiology; Prosthesis-Related Infections - surgery; Recurrence; Reoperation; Saphenous Vein - transplantation; Surgery; Tomography, X-Ray Computed; Treatment Outcome; Vascular Diseases - surgery
• ISSN: 0741-5214; 1097-6809
• DOI: 10.1016/j.jvs.2012.10.069

Mesenteric prosthetic graft infection is a rare and challenging clinical scenario. A patient is described who developed recurrent abdominal pain after occlusion of an iliomesenteric prosthetic bypass. Endovascular recanalization of the native superior mesenteric artery, which had been occluded for more than 10 years, was accomplished using axillofemoral through-wire access and a steerable guiding catheter. The infected prosthetic was then explanted and his graft-enteric fistula repaired. Technical and strategic considerations are discussed.