Femoral–Femoral Artery Artificial Vascular Bypass: A Promising Therapy for Infectious Arteritis After Kidney Transplantation

Objective Infectious arteritis involving the iliac arteries is a rare but severe complication after kidney transplantation, frequently leading to graft loss and mortality. Direct repair within infected fields is often unsuccessful. We report outcomes of femoral–femoral artery artificial vascular bypass (Fem–Fem bypass) as a strategy to exclude infected arterial segments and preserve limb perfusion in five such cases. Method Retrospective analysis of four kidney transplant recipients who developed infectious arteritis (external iliac artery) with rupture or aneurysm between January 2015 and January 2023. All underwent resection of the infected arterial segment with proximal/distal ligation and extra‐anatomic Fem–Fem bypass using a synthetic graft. Results Among the four patients, two were infected with carbapenem‐resistant Pseudomonas aeruginosa (CRPA), one with carbapenem‐resistant Enterobacteriaceae (CRE), and one with mucormycosis. All underwent Fem‐Fem bypass following resection of the infected arterial segment. One patient with CRPA infection died 5 months postoperatively due to septicemia and multiorgan failure. The remaining three patients survived with functional grafts and patent bypasses at follow‐up, without recurrence of infection or vascular complications. Conclusions Fem–Fem bypass effectively controls hemorrhage or aneurysm expansion and maintains limb perfusion by excluding the infected iliac arterial segment in kidney transplant recipients with infectious arteritis. It represents a viable salvage option when endovascular repair fails or is contraindicated. Long‐term success depends on effective infection control, appropriate antimicrobial therapy, and patient‐specific factors. Mortality remains significant in cases with systemic sepsis or highly resistant pathogens.