Differential Flows in the Aortic Graft following Open Surgery of Infra-renal Aortic and Iliac Aneurysm

We present a case of combined abdominal and iliac artery aneurysm in 60-year-old male patient who previously had undergone bilateral below knee amputation of both legs due to embolization and subsequent gangrene. Patient was a chronic smoker and was also suffering from hypertension. Computed tomographic (CT) angiogram showed large aneurysm of the infrarenal aorta and right common iliac artery. Surgical intervention in the form of aneurysmorrhapy and aorto-biiliac grafting was done using 20 mm × 10 mm knitted gelatin impregnated bifurcation Dacron graft. The patient recovered well and was discharged after 10 days, post-operative CT angiogram done after 1 month showed difference of contrast enhancement in the anterior and posterior aspects of the graft, probably due to differential flows, turbulence, and stasis and thereby increasing the risk of graft thrombosis