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Title: Late Complication after Superficial Femoral Artery (SFA) Aneurysm: Stent-graft Expulsion Outside the Skin

Abstract

A 78-year-old man presented with a 7-cm aneurysm in the left superficial femoral artery, which was considered unfit and anatomically unsuitable for conventional open surgery for multiple comorbidities. The patient was treated with stent-graft [Viabhan stent-graft (WL Gore and Associates, Flagstaff, AZ)]. Two years from stent-graft implantation, the patient presented a purulent secretion and a spontaneous external expulsion through a fistulous channel. No claudication symptoms or hemorrhagic signs were present. The pus and device cultures were positive for Staphylococcus aureus sensitive to piperacillin/tazobactam. Patient management consisted of fistula drainage, systemic antibiotic therapy, and daily wound dressing. At 1-month follow-up, the wound was closed. To our knowledge, this is the first case of this type of stent-graft complication presenting with external expulsion.

Authors:
; ; ; ; ;  [1]
  1. University of Palermo, Vascular Surgery Unit (Italy)
Publication Date:
OSTI Identifier:
22469740
Resource Type:
Journal Article
Resource Relation:
Journal Name: Cardiovascular and Interventional Radiology; Journal Volume: 38; Journal Issue: 5; Other Information: Copyright (c) 2015 Springer Science+Business Media New York and the Cardiovascular and Interventional Radiological Society of Europe (CIRSE); http://www.springer-ny.com; Country of input: International Atomic Energy Agency (IAEA)
Country of Publication:
United States
Language:
English
Subject:
62 RADIOLOGY AND NUCLEAR MEDICINE; ANTIBIOTICS; ARTERIES; BIOMEDICAL RADIOGRAPHY; GRAFTS; MAN; MANAGEMENT; PATIENTS; SECRETION; SKIN; STAPHYLOCOCCUS; SURGERY; SYMPTOMS; THERAPY; WOUNDS

Citation Formats

Pecoraro, Felice, E-mail: felicepecoraro@libero.it, Sabatino, Ermanno R., Dinoto, Ettore, Rosa, Giuliana La, Corte, Giuseppe, and Bajardi, Guido. Late Complication after Superficial Femoral Artery (SFA) Aneurysm: Stent-graft Expulsion Outside the Skin. United States: N. p., 2015. Web. doi:10.1007/S00270-014-0970-6.
Pecoraro, Felice, E-mail: felicepecoraro@libero.it, Sabatino, Ermanno R., Dinoto, Ettore, Rosa, Giuliana La, Corte, Giuseppe, & Bajardi, Guido. Late Complication after Superficial Femoral Artery (SFA) Aneurysm: Stent-graft Expulsion Outside the Skin. United States. doi:10.1007/S00270-014-0970-6.
Pecoraro, Felice, E-mail: felicepecoraro@libero.it, Sabatino, Ermanno R., Dinoto, Ettore, Rosa, Giuliana La, Corte, Giuseppe, and Bajardi, Guido. 2015. "Late Complication after Superficial Femoral Artery (SFA) Aneurysm: Stent-graft Expulsion Outside the Skin". United States. doi:10.1007/S00270-014-0970-6.
@article{osti_22469740,
title = {Late Complication after Superficial Femoral Artery (SFA) Aneurysm: Stent-graft Expulsion Outside the Skin},
author = {Pecoraro, Felice, E-mail: felicepecoraro@libero.it and Sabatino, Ermanno R. and Dinoto, Ettore and Rosa, Giuliana La and Corte, Giuseppe and Bajardi, Guido},
abstractNote = {A 78-year-old man presented with a 7-cm aneurysm in the left superficial femoral artery, which was considered unfit and anatomically unsuitable for conventional open surgery for multiple comorbidities. The patient was treated with stent-graft [Viabhan stent-graft (WL Gore and Associates, Flagstaff, AZ)]. Two years from stent-graft implantation, the patient presented a purulent secretion and a spontaneous external expulsion through a fistulous channel. No claudication symptoms or hemorrhagic signs were present. The pus and device cultures were positive for Staphylococcus aureus sensitive to piperacillin/tazobactam. Patient management consisted of fistula drainage, systemic antibiotic therapy, and daily wound dressing. At 1-month follow-up, the wound was closed. To our knowledge, this is the first case of this type of stent-graft complication presenting with external expulsion.},
doi = {10.1007/S00270-014-0970-6},
journal = {Cardiovascular and Interventional Radiology},
number = 5,
volume = 38,
place = {United States},
year = 2015,
month =
}
  • 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
  • Endovascular stent placement and coil embolization have become established options in the treatment of visceral arterial aneurysms. In this article we report the case of an 83-year-old presenting with gastrointestinal hemorrhage due to a recurrent hepatic arterial aneurysm occurring 12 years after treatment with an endovascular stent. The recurrent aneurysm had resulted from stent fracture and was successfully treated by coil embolization. To our knowledge, stent fracture complicating the endovascular treatment of a visceral artery aneurysm has not been described in the published literature. With the increasing use of metallic endoprostheses in interventional radiology, recognizing and reporting device failure aremore » of critical importance.« less
  • 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
  • No abstract prepared.
  • Purpose. To evaluate the efficacy of iliac artery stent placement for relief of claudication in patients with both iliac and superficial femoral artery (SFA) lesions. Methods. Stent placement for only iliac artery occlusive disease was performed in 94 limbs (74 patients) with both iliac and SFA occlusive disease on the same limb. All procedures were performed because intermittent claudication did not improve after continuation of antiplatelet medication therapy and home-based exercise for 3 months. Rutherford classification was 2 in 20 limbs and 3 in 74 limbs. Patients with critical limb ischemia were excluded. Median duration of follow-up was 40 months.more » Primary patency rates of the iliac stent, clinical improvement rates, and risk factors for requiring additional SFA procedures were evaluated. Results. Primary patency rates of the iliac stent at 1, 3, 5, and 7 years were 97, 93, 79, and 79 %, respectively. The initial clinical improvement rate was 87 %. Continued clinical improvement rates at 1, 3, 5, and 7 years were 87, 81, 69, and 66 %, respectively. SFA Trans-Atlantic Inter-Society Consensus (TASC) II C/D lesion was a significant risk factor for requiring additional SFA procedures. Conclusion. Intermittent claudication was relieved by iliac stent placement in most patients with both iliac and SFA lesions. Thus, the indications for treatment of the SFA intended for claudicants should be evaluated after treatment of the iliac lesion.« less