Acute aortobiliac graft thrombosis.

Introduction and Importance: Acute limb ischemia after infrarenal aortic repair is a rare complication, which in mainly described to appear in a short time after surgery.The aim of this paper is to describe a case of a 66-year-old woman who presented at out attention with acute right limb ischemia, one year later an aortic repair for acute abdominal aortic aneurysm rupture. In the best of our knowledge there are no cases of sudden graft occlusion after such long time, described in literature.

Case presentation: Patient presented with sudden pain and pallor in the right lower limb and subsequently same symptoms to the left lower limb. One year before she underwent an emergency repair for abdominal aortic aneurysm rupture with an aortobiliac graft. Computed Tomography Angiography (CTA) scan showed a complete occlusion of the infrarenal aorta, including aortoiliac graft, to the common bilateral iliac arteries. On the right side was also found a complete occlusion of the popliteal artery.Emergent embolectomy of the right popliteal artery via the femoral artery was performed.

Clinical discussion: CTA scan performed on third post-operative day showed the patency of infrarenal aorta and aortic portion of the grafts in presence of floating thrombus, right iliac branch patency and chronic occlusion of left iliac branch. A kinking of both graft iliac branches was evident after this CTA scan. CTA scan at one month demonstrated resolution of the thrombosis of the infrarenal aorta, complete patency of aortic portion of the graft and right iliac branch and chronic obstruction of the left common iliac artery.

Conclusion: Acute limb ischemia caused by sudden graft occlusion one year later an aortic repair for acute abdominal aortic aneurysm rupture is a very rare event. Graft limbs kinking could explain acute thrombosis of the graft.