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Title: Spontaneous Rupture of Superficial Femoral Artery Repaired with Endovascular Stent-Grafting with use of Rendez-Vous Technique, Followed by Delayed Infection

Abstract

This is the case of a 72-year-old man with lower limb ischemia due to spontaneous rupture of nonaneurysmal superficial femoral artery that developed into thigh hematoma. After failure of a Fogarty revascularization, an emergency endovascular procedure was performed to restore the arterial continuity. A rendezvous procedure was performed with a double femoral and popliteal approach and two covered stent-grafts were deployed. Patient's clinical conditions immediately improved, but 4 months later the stent-grafts were surgically removed for infection and exteriorization. A femoropopliteal bypass was performed. After 1 year follow-up, the patient is in good clinical condition.

Authors:
;  [1];  [2]; ;  [3];  [2]
  1. University of Rome 'Sapienza,', Department of Radiological Sciences, Vascular and Interventional Radiology Unit (Italy)
  2. Sapienza University of Rome 'Sapienza,', Department of Surgery Paride Stefanini, Vascular Surgery Division, Policlinico Umberto I (Italy)
  3. University of Rome 'Sapienza,', Department of Vascular Surgery (Italy)
Publication Date:
OSTI Identifier:
22156509
Resource Type:
Journal Article
Resource Relation:
Journal Name: Cardiovascular and Interventional Radiology; Journal Volume: 36; Journal Issue: 1; Other Information: Copyright (c) 2013 Springer Science+Business Media New York and the Cardiovascular and Interventional Radiological Society of Europe (CIRSE); Article Copyright (c) 2012 Springer Science+Business Media, LLC and the Cardiovascular and Interventional Radiological Society of Europe (CIRSE); Country of input: International Atomic Energy Agency (IAEA)
Country of Publication:
United States
Language:
English
Subject:
62 RADIOLOGY AND NUCLEAR MEDICINE; ARTERIES; GRAFTS; HEMATOMAS; ISCHEMIA; LIMBS; MAN; PATIENTS; RUPTURES; SURGERY

Citation Formats

Fanelli, Fabrizio, E-mail: fabrizio.fanelli@uniroma1.it, Cannavale, Alessandro, Gazzetti, Marianna, Fantozzi, Cristiano, Taurino, Maurizio, and Speziale, Francesco. Spontaneous Rupture of Superficial Femoral Artery Repaired with Endovascular Stent-Grafting with use of Rendez-Vous Technique, Followed by Delayed Infection. United States: N. p., 2013. Web. doi:10.1007/S00270-012-0384-2.
Fanelli, Fabrizio, E-mail: fabrizio.fanelli@uniroma1.it, Cannavale, Alessandro, Gazzetti, Marianna, Fantozzi, Cristiano, Taurino, Maurizio, & Speziale, Francesco. Spontaneous Rupture of Superficial Femoral Artery Repaired with Endovascular Stent-Grafting with use of Rendez-Vous Technique, Followed by Delayed Infection. United States. doi:10.1007/S00270-012-0384-2.
Fanelli, Fabrizio, E-mail: fabrizio.fanelli@uniroma1.it, Cannavale, Alessandro, Gazzetti, Marianna, Fantozzi, Cristiano, Taurino, Maurizio, and Speziale, Francesco. 2013. "Spontaneous Rupture of Superficial Femoral Artery Repaired with Endovascular Stent-Grafting with use of Rendez-Vous Technique, Followed by Delayed Infection". United States. doi:10.1007/S00270-012-0384-2.
@article{osti_22156509,
title = {Spontaneous Rupture of Superficial Femoral Artery Repaired with Endovascular Stent-Grafting with use of Rendez-Vous Technique, Followed by Delayed Infection},
author = {Fanelli, Fabrizio, E-mail: fabrizio.fanelli@uniroma1.it and Cannavale, Alessandro and Gazzetti, Marianna and Fantozzi, Cristiano and Taurino, Maurizio and Speziale, Francesco},
abstractNote = {This is the case of a 72-year-old man with lower limb ischemia due to spontaneous rupture of nonaneurysmal superficial femoral artery that developed into thigh hematoma. After failure of a Fogarty revascularization, an emergency endovascular procedure was performed to restore the arterial continuity. A rendezvous procedure was performed with a double femoral and popliteal approach and two covered stent-grafts were deployed. Patient's clinical conditions immediately improved, but 4 months later the stent-grafts were surgically removed for infection and exteriorization. A femoropopliteal bypass was performed. After 1 year follow-up, the patient is in good clinical condition.},
doi = {10.1007/S00270-012-0384-2},
journal = {Cardiovascular and Interventional Radiology},
number = 1,
volume = 36,
place = {United States},
year = 2013,
month = 2
}
  • Spontaneous rupture of the superficial femoral artery (SFA) is rare. It may occur in the presence of an SFA aneurysm or in a nonaneurysmal, but usually atherosclerotic, artery. Previously these ruptures have been treated by surgical exclusion, often with bypass grafting. We report a case of spontaneous rupture of a nonaneurysmal SFA treated successfully with endovascular stent-grafting.
  • In-stent reocclusion is a frequent complication of endovascular treatment and stenting, especially in the superficial femoral artery. Neointimal hyperplasia is the main cause of this problem, but in many cases, it occurs as a result of the presence of stent strut fractures. The two treatment options are endovascular and surgical intervention. The effectiveness of endovascular interventions in patients with critical limb ischemia has been well established, but in some cases, crossing the occluded stent is difficult. We describe a new technique to recanalize long in-stent superficial femoral artery occlusions characterized by direct stent puncture, followed by retrograde-antegrade recanalization after antegrademore » failures.« less
  • Introduction: Bacterial infection of endovascular stent grafts is a serious condition, regularly leading to graft replacement by open bypass surgery.Case ReportWe describe the case of a staphylococcal infection of a 150-mm covered stent graft (Gore Viabahn), placed in the superficial femoral artery. Stent graft infection was successfully treated by oral administration of penicillinase-resistant flucloxacillin and the lipopeptide daptomycin with complete graft preservation, not requiring surgical treatment. During 1-year follow-up, the graft infection did not reappear. However, the patient developed restenosis at the proximal margin of the stent with recurrence of mild claudication, so far treated conservatively. Conclusion: With the increasedmore » use of covered stent grafts in the peripheral vasculature, the frequency of graft infection will increase. We demonstrate that with newly developed antibiotics, it is possible to treat this severe complication conservatively, with complete graft preservation and without the need for bypass surgery in selected cases.« less
  • A 25-year-old man developed sudden pain and a pulsating mass in the left thigh. A diagnosis of Behcet's disease was made because of four major symptoms. Laboratory data indicated active inflammation. Emergency spiral computed tomographic angiography (CTA) showed an aneurysm of the left superficial femoral artery (SFA). Under steroid therapy, follow-up spiral CTA showed spontaneous occlusion of the aneurysm. In the active phase of arteritis, spiral CTA is useful for the diagnosis of arterial lesions to avoid the arterial puncture of conventional arteriography.
  • Endovascular treatment of the superficial femoral artery (SFA) is challenging in the presence of flush ostial occlusion. One of the main challenges is the availability of access sites for intervention. Contralateral retrograde femoral access followed by cross-over and antegrade intervention while commonly used, may not be feasible in cases of altered iliac anatomy (e.g. kissing iliac stents). Ipsilateral antegrade intervention using common femoral artery (CFA) access in these instances while possible is typically challenging due to inadequate working length of the CFA for interrogation of the SFA ostium, compounded by the lack of sheath stability. The “profunda anchor” technique usesmore » a buddy wire in the profunda femoris artery (PFA) to stabilize the sheath and allow catheter manipulation for antegrade intervention at the level of the SFA ostium. The PFA is further used as a conduit for deployment of closure device to avoid interference with the treated SFA.« less