CARDIOVASCULAR JOURNAL OF AFRICA • Volume 34, No 1, January–April 2023 AFRICA 49 Follow-up angiogram and sonograms were negative for graftrelated complications such as anastomotic stenosis, involved thrombus or aneurysms. However, the patient presented with the complaint of a palpable pulsatile mass in the left lower extremity but no other complaints were described. There was no history of trauma or soft tissue infection. In addition to his peripheral vascular disease, his history was also significant for coronary artery disease, hypertension, dyslipidaemia and previous tobacco use. Physical examination was unremarkable except for a palpable pulsatile mass on the graft trace in the left lower extremity. In addition to the patent left femoropopliteal bypass graft, a computed tomography angiogram of the lower extremities further illuminated the 48 × 15-mm fusiform aneurysm at the junction of the middle third of the femoropopliteal bypass graft (Fig. 1A). The aneurysm was close to the proximal anastomosis site, and the distal anastomosis site was intact (Fig. 2A). The patient was informed about the aneurysm repair operation and written consent was obtained from the patient for the publication of this case report. Before the procedure, the patient underwent detailed venous mapping for the great saphenous vein. Nevertheless, it was decided that the diameter (< 3 mm) of the great saphenous vein was not suitable for the graft. Therefore, a synthetic graft was preferred. During the operation, the abnormal segment was resected and the graft was repaired with a 10-mm polytetrafluoroethylene (PTFE) graft interposition under antibiotic cover (Figs 1B, 2B). Post-operatively the patient made a good recovery and was discharged five days after the operation. No organisms were cultured from the graft or thrombus. Discussion Due to the problems of patency, durability, infection, graft–host reactions and ease of use of biological and synthetic grafts Fig. 2. Aneurysmatic view (white arrows) of the patient’s left femoral artery vascular biosynthetic graft (Omniflow II). A. The view of the synthetic vascular graft inserted in place of the old aneurysmatic graft in the left femoral artery (B). A B
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