A Case of Bilateral Obturator Foramen Bypass
We report a case of a bilateral obturator foramen bypass for repeatedly infected vascular prostheses of both inguinal regions occurring at different times. A 85-year-old man was admitted into our hospital because redness and swelling of the right inguinal region of unknown origin. He had previously been treated for the same clinical signs and symptoms as this time. He had a past history of femoro-femoral cross over bypass for arteriosclerosis obliterans at 81 years of age. Although at the age of 83 years the inguinal region was washed for about one month with a saline solution containing povidone iodine for the first infection, his condition did not improve. Therefore, femoro-femoral cross over bypass graft was removed, and a right axillary-femoral bypass and a left obturator foramen bypass were performed. His postoperative course was uneventful, but redness and swelling of the right inguinal region of unknown origin similarly appeared again 2 years later. The right axillary-femoral bypass graft from the flank to the right femoral artery was removed, and using a 6 mm ringed expanded polytetrafluoroethylene (ePTFE), a right obturator foramen bypass was performed from the stump division of the flank of the right axillary-femoral bypass graft to a superficial femoral artery in the middle thigh through the retroperitoneum and obturator foramen. There has been no recurrence to date, but sufficient follow up is required. We concluded that the obturator foramen bypass is a safe and satisfactory method of treatment for patient with groin infections after previous revascularization.