Perigraft hemorrhage after abdominal aortic aneurysm repair in a heart transplant patient.

Spontaneous perigraft hemorrhage can occur years after a successful aortic aneurysm repair. Such hemorrhage can result, in part, from inadequate graft healing. Herein, we describe the case of a heart transplant recipient who underwent an abdominal aortic aneurysm repair that was complicated by an acute perigraft leak 6 weeks later. Apparently, suppression of the patient's immune system impaired proper healing of the graft-aortic anastomosis site. In patients who have a compromised immune system, an additional 4-0 polypropylene pledgeted suture line should be placed for reinforcement during abdominal aortic aneurysm repair. Postoperatively, patients who are given immunosuppressive therapy should undergo careful, long-term monitoring.