Extra-anatomic bypass of failed traumatic arterial repairs

J Trauma. 1991 Apr;31(4):575-8. doi: 10.1097/00005373-199104000-00019.


Arterial injuries are best treated by primary repair or anatomically placed interposition grafts. Occasionally, these repairs fail due to adverse local factors, such as soft-tissue infection or enteric contamination. In these instances, limb salvage may require extra-anatomic arterial reconstruction. Between 1979 and 1989, 13 extra-anatomic bypasses were performed in ten male patients following nine failed primary repairs and one ligation of a traumatic arterial injury. The sites of arterial injury were: aorta (two), iliac (five), femoral (two), popliteal (one). Enteric contamination was present at initial operation in six patients; the remaining four had sustained massive soft-tissue injury. Reoperation was required for hemorrhage (seven), pseudoaneurysm (two), and arteriovenous fistula (one). All patients had developed local wound problems that militated against another anatomic repair. Extra-anatomic bypasses performed were: axillo-femoral (three), femoro-femoral (four), obturator (one), and two extra-anatomic femoral to popliteal saphenous vein grafts routed around an infected field. A second extra-anatomic reconstruction was performed for recurrent hemorrhage in three patients, (axillo-femoral--two, obturator--one). One patient with a neuropathic extremity and a functioning graft underwent amputation at 2 months following the initial injury. Two patients died of systemic sepsis. Seven patients (70%) have functional extremities with intact pulses at 2 to 24 months post bypass (mean, 7 months). Limb salvage after secondary disruption of secondarily infected arterial repairs can be achieved by appropriate extra-anatomic arterial reconstruction. In such cases, limb loss is due to soft-tissue sepsis or neuro-skeletal injuries and not vascular insufficiency.

MeSH terms

  • Adult
  • Anastomosis, Surgical
  • Aorta / injuries
  • Aorta / surgery
  • Arteries / injuries*
  • Arteries / surgery
  • Bacterial Infections / complications
  • Bacterial Infections / surgery
  • Blood Vessel Prosthesis
  • Femoral Artery / injuries
  • Femoral Artery / surgery
  • Humans
  • Iliac Artery / injuries
  • Iliac Artery / surgery
  • Ligation
  • Male
  • Popliteal Artery / injuries
  • Popliteal Artery / surgery
  • Postoperative Complications / surgery
  • Reoperation
  • Sepsis / etiology