Non-Anastomotic Complete ePTFE Axillobifemoral Bypass Disruption and Thrombosis Following Shoulder Dislocation

Complete disruption of an expanded polytetrafluoroethylene (ePTFE) vascular graft is rare. This is a report of a case of a 70 year old man presenting with left shoulder dislocation, which was reduced immediately. Two weeks later, the patient presented with Rutherford 2b bilateral lower limb ischaemia related to the thrombosis of an ePTFE axillobifemoral bypass. The graft was implanted five years earlier for treatment of an aorto-enteric fistula secondary to an infected aortobifemoral bypass. A non-anastomotic pseudoaneurysm associated with complete disruption of the ePTFE graft was found. Systematic analysis of the explant showed that the rupture occurred at the level of a ringed external support and that ongoing tears also occurred on the posterior wall of the graft at the level of this external support. In conclusion, complete analysis of failure mechanisms even from an isolated report is mandatory.