This case involves a middle-aged female patient with a history of poor circulation who presented with persistent foot pain. She underwent a cardiac bypass graft and was discharged home after the designated recovery period. A few days later, the patient returned to the emergency room with a sudden onset of groin swelling. An abdominal CT angiogram showed a large groin hematoma, and the patient went into cardiac arrest from severe septic shock. Once stabilized, the patient underwent an exploratory surgery. Intraoperatively, it was discovered that part of the graft had perforated the intestine. The patient still suffers complications as a result of the severe sepsis that resulted. An expert in vascular surgery with extensive experience in these procedures was sought to review the perioperative course of the aortobifemoral bypass and delayed detection of the perforation.
Question(s) For Expert Witness
- 1. Please describe your experience managing patients requiring aortobifemoral bypass graft surgeries?
- 2. Have you ever observed this type of perforation or other similar complications arise from this surgical intervention?
Expert Witness Response E-001075
I am the training program director of a vascular surgery fellowship program and an integrated residency program at a large academic referral hospital. In addition to having a busy clinical practice, I am a faculty member at a top 5 US medical school. I am often lecturing and training others on the importance of surgical complication prevention, recognition, and treatment. While endovascular techniques have potentially become the preferred method for revascularization, there are still clinical situations that require open surgical bypass. I am abundantly familiar with the indications, techniques and the complications related to an aortobifemoral (ABF) artery bypass surgery. During the completion of the ABF bypass, individual limbs are tunneled through the retroperitoneal space from the intra-abdominal cavity (aorta) to the infrainguinal location (femoral arteries). This part of the procedure must be completed carefully or complications such as perforation, bleeding, or injuries can occur to adjacent organs.