Limb Salvage in a Setting of Recurrent Groin Infection: Multimodal Approach with Review of Literature

Groin complications after lower extremity revascularization pose a challenge with graft infection and pseudoaneurysm, carrying a high risk of morbidity and mortality, often necessitating multiple procedures. We report a 64-year-old hypertensive man with a history of femoropopliteal bypass for chronic limb-threatening ischemia, developing a cascade of problems beginning with graft infection that required explantation and progressing to a 7.6 cm common femoral artery pseudoaneurysm presenting with a herald rupture. Initial control was achieved with emergency endovascular balloon control, followed by autogenous arterial bypass; recurrent infection with exposed conduit subsequently required endovascular stent-graft salvage. Soft-tissue coverage was obtained with a transverse rectus abdominis myocutaneous flap, resulting in complete wound healing. This illustrates complex, recurrent groin complications that necessitated multidisciplinary decision-making and coordinated management with open reconstruction, endovascular salvage, and surgical reconstruction to achieve limb preservation.