Penetration of the Iliac Bone as a Modified Tunneling Option for Graft Infection in the Groin

A graft infection is one of the most fatal complications after surgical treatment for arteriosclerosis obliterans. Although both redo arterial revascularization for limb salvage and prevention of recurrent infection are necessary for the treatment of an infected prosthetic graft, surgical strategy is extremely troublesome and challenging. We successfully performed the extra-anatomic bypass by penetrating an iliac bone, in 3 cases. The anterior aspect of iliac crest was exposed through pararectal retroperitoneal incision. The hole in the iliac bone can be easily made by an electric scalpel. In performing redo arterial revascularization for the prosthetic vascular graft infection, reconstructing the extra-anatomic bypass by penetrating an iliac bone is one of the most advantageous treatments. This surgical strategy can help to select the flexible bypassed route, isolate the infected site, and completely eradicate its area of infection for wound healing.