Complete non-anastomotic rupture of an axillobifemoral PTFE bypass following blunt chest trauma: A case report.

BACKGROUND: Non-anastomotic disruption of an axillofemoral bypass graft is an exceedingly rare but potentially life-threatening complication. Most reported cases present with a delayed pseudoaneurysm, whereas acute complete graft disruption with active hemorrhage is exceptional. CASE PRESENTATION: A man in his late 50s with a history of a left axillobifemoral PTFE bypass performed in 2022 for chronic aorto-iliac occlusive disease presented to the emergency department with acute left thoracic and upper-limb pain and a rapidly developing pulsatile thoracic swelling following blunt chest trauma against the edge of a table. Computed tomography angiography demonstrated a large left anterior chest-wall hematoma communicating with the axillobifemoral graft and associated active bleeding. Emergency surgical exploration was undertaken. A complete transverse rupture of the graft was identified in the non-anastomotic portion, with no disruption of either the proximal or distal arterial anastomosis. The graft was repaired by direct end-to-end prosthesis-to-prosthesis anastomosis. The postoperative course was uneventful with preserved graft patency and good clinical outcome. A distal clavicular fracture was subsequently identified. CONCLUSION: Complete non-anastomotic rupture of an axillobifemoral PTFE graft following blunt trauma is extremely uncommon but should be considered in patients with a previous axillofemoral bypass who develop acute chest-wall pain, swelling, or hemorrhage after trauma. Prompt CTA and emergency surgical management are essential because delayed diagnosis may result in life-threatening hemorrhage.