Eur J Vasc Endovasc Surg 19, 92–93 (2000) doi:10.1053/ejvs.1999.0973, available online at http://www.idealibrary.com on LESSON OF THE MONTH A Long Distal Prosthetic Bypass Grafting from Descending Aorta to Distal Peroneal Artery. Sometimes It Works! S. Karacagil* 1 , S. Thelin 2 , L. Nilsson 2 , H. Ahlstro ¨m 3 and D. Bergqvist 1 Departments of 1 Surgery, 2 Thoracic Surgery and 3 Radiology, University Hospital, Uppsala, Sweden Introduction through the Dacron graft failed. Exploration of the popliteal artery and the tibioperoneal trunk dem- Grafts in large arteries with high flow rate have ex- onstrated severe atherosclerotic changes, but the distal peroneal artery was patent. A bypass graft from the cellent patency rates. On the other hand, prosthetic grafts, especially when long and anastomosed to the previous Dacron graft in the groin to the distal peroneal artery was performed with an expanded po- crural arteries, continue to frequently fail. We report on a patient in whom the results of several staged lytetrafluoroethylene (PTFE, Gore-Tex) graft and a distal modified vein cuff. 1 Thirty minutes after surgery aortic and distal reconstructions ended with a long synthetic tube consisting of three different prosthetic the graft occluded and the patient underwent re- exploration with thrombectomy through the PTFE grafts and a distal vein collar from the proximal des- cending aorta to the distal peroneal artery. graft above the vein collar. There was no obvious reason for occlusion. He had uneventful recovery and was discharged from the hospital 3 weeks post- operatively. Duplex scanning at 1, 3, 6, 12, 18, 24 and Case Report 36 months demonstrated a patent distal graft without stenosis. He is free of symptoms and contrast-enhanced A 59-year-old man with a previous infrarenal aortic MR angiography demonstrated patent graft from the aneurysm replacement (1986) with a bifurcated Dacron descending aorta to the peroneal artery at 36 months graft to the left common iliac and right common (Fig. 1). He is being treated with life-long warfarin. femoral artery developed a thoracoabdominal an- eurysm (maximum diameter 7 cm). Computed tomo- graphy (CT) scanning demonstrated a patent infrainguinal aortic graft and an atrophic kidney on Discussion the left side. A thoracoabdominal Dacron graft from the left subclavian artery to the previous infrarenal Autogenous vein is the graft of choice in infrainguinal graft was inserted during total circulatory arrest and bypass procedures and the graft material is one im- deep hypothermia. Two hours postoperatively, acute portant factor affecting early and late outcome. The arterial occlusion was detected in the right leg. He most common direct prosthetic graft complication in had a history of claudication and an ankle–brachial the femorocrural position is thrombosis. Femorodistal index of 0.7 before surgery. He underwent immediate bypass with prosthetic graft material, even in patients exploration of the right groin, which revealed patent with favourable prerequisites, continues to fail due anastomosis on the common femoral artery, and a to the thrombogenic nature of the material. Long thrombectomy attempted with a Fogarty catheter prosthetic femorodistal bypass grafts have unaccept- ably low patency rates and every attempt should be made to use autogenous vein. Our patient had a poor- * Please address all correspondence to: S. Karacagil, Department of Surgery, University Hospital, Uppsala SE-751 85, Sweden. quality saphenous vein with a diameter of less than 1078–5884/00/010092+02 $35.00/0  2000 Harcourt Publishers Ltd.