Don't Stop Pulling the Leg (of the Graft)!

In 2010, a 77 year old patient was treated for ruptured abdominal aortic aneurysm with an 80 mm maximum diameter. He underwent emergency aortobi-iliac bypass (white arrows). The post-operative course was uneventful. He progressively developed an asymptomatic stenosis of the left limb screened by ultrasound. Panel A shows the early post-operative computed tomography angiography image, and panel B shows the legs’ folding 12 years later. Shrinkage of the residual aneurysm sac caused the folding of the legs. The patient successfully underwent redo surgery with shortening of both legs and direct anastomosis. Grafts need to be pulled as much as possible to avoid future kinking!