Tatsu Nakazawa

Conservative management of a methicillin-resistant Staphylococcus aureus (MRSA)-infected aortobifemoral graft: report of a case.

A 63-year-old man was referred to our department for treatment of intermittent claudication in the right lower limb. The preoperative angiogram showed severe stenosis extending from the terminal aorta to the bilateral common femoral arteries, with occlusion of the right superficial femoral artery and the left popliteal artery. He underwent aortobifemoral bypass with thromboendarterectomy of the left common femoral artery, and right graft-popliteal artery bypass. The patient had an uneventful postoperative course; however, 14 days after the operation, a pulsatile mass suddenly appeared in the left groin. Emergency surgery revealed disruption of the left distal anastomosis of the aortobifemoral bypass and therefore, revision, in the form of graft-profunda femoris artery interposition with graft-superficial femoral artery bypass, was performed. Microscopic examination showed colonies of bacteria in the host artery adventitia adjacent to the anastomosis. Culture of the discharge from the right groin operative scar revealed methicillin-resistantStaphylococcus aureus (MRSA). The discharge resolved following the intravenous administration of vancomycin and the local application of vancomycin ointment. There were no operative complications other than the MRSA infection, and the patient was discharged 20 days after revision surgery. In the 14 months since the revision, all grafts have remained patent and there have been no further symptoms of graft infection.

Intermittent Claudication Caused by Small Aorta Syndrome: A Case Report and Review of Literature

Aortoiliac arterial steno-occlusions in young or middle-aged patients are relatively rare and have been reported in the literature as small aorta syndrome (SAS) or hypoplastic aortoiliac syndrome. We report the case of a 48-year-old Japanese woman with intermittent claudication caused by SAS. We performed left iliofemoral bypass grafting with a Dacron graft via a retroperitoneal approach. Bypass grafts, endarterectomy, and sympathectomy have been used for surgical management. Given that post-procedural event rates are higher for SAS than for other common atherosclerotic diseases, patients with SAS should be closely followed up after surgery.