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Title: Endovascular Management of Infected Femoral Artery Pseudoaneurysms in High-Risk Patients: A Case Series

Abstract

We report our experience with the urgent treatment of two high-risk patients with infected femoral artery pseudoaneurysms (IFAPs) with the placement of a self-expandable covered stent (SECS). In both cases, there was no perioperative mortality and the aneurysm exclusion was successful without early or late stent thrombosis/stent fracture nor acute or chronic limb ischemia or limb loss. There was no recurrence of local or systemic infection during the follow-up period. Endovascular therapy represents a feasible treatment option for IFAPs in those patients for whom the risk of open surgical repair would be prohibitive, especially under urgent circumstances.

Authors:
; ; ; ; ; ;  [1]
  1. University Hospital of Cattinara, Vascular and Endovascular Surgery Unit (Italy)
Publication Date:
OSTI Identifier:
22645250
Resource Type:
Journal Article
Resource Relation:
Journal Name: Cardiovascular and Interventional Radiology; Journal Volume: 40; Journal Issue: 4; Other Information: Copyright (c) 2017 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; ARTERIES; BIOMEDICAL RADIOGRAPHY; BONE FRACTURES; HAZARDS; ISCHEMIA; LIMBS; MORTALITY; PATIENTS; REPAIR; SURGERY; THERAPY; THROMBOSIS

Citation Formats

D’Oria, Mario, E-mail: mario.doria88@outlook.com, Sgorlon, Giada, Calvagna, Cristiano, Zamolo, Francesca, Chiarandini, Stefano, Adovasio, Roberto, and Griselli, Filippo. Endovascular Management of Infected Femoral Artery Pseudoaneurysms in High-Risk Patients: A Case Series. United States: N. p., 2017. Web. doi:10.1007/S00270-016-1527-7.
D’Oria, Mario, E-mail: mario.doria88@outlook.com, Sgorlon, Giada, Calvagna, Cristiano, Zamolo, Francesca, Chiarandini, Stefano, Adovasio, Roberto, & Griselli, Filippo. Endovascular Management of Infected Femoral Artery Pseudoaneurysms in High-Risk Patients: A Case Series. United States. doi:10.1007/S00270-016-1527-7.
D’Oria, Mario, E-mail: mario.doria88@outlook.com, Sgorlon, Giada, Calvagna, Cristiano, Zamolo, Francesca, Chiarandini, Stefano, Adovasio, Roberto, and Griselli, Filippo. Sat . "Endovascular Management of Infected Femoral Artery Pseudoaneurysms in High-Risk Patients: A Case Series". United States. doi:10.1007/S00270-016-1527-7.
@article{osti_22645250,
title = {Endovascular Management of Infected Femoral Artery Pseudoaneurysms in High-Risk Patients: A Case Series},
author = {D’Oria, Mario, E-mail: mario.doria88@outlook.com and Sgorlon, Giada and Calvagna, Cristiano and Zamolo, Francesca and Chiarandini, Stefano and Adovasio, Roberto and Griselli, Filippo},
abstractNote = {We report our experience with the urgent treatment of two high-risk patients with infected femoral artery pseudoaneurysms (IFAPs) with the placement of a self-expandable covered stent (SECS). In both cases, there was no perioperative mortality and the aneurysm exclusion was successful without early or late stent thrombosis/stent fracture nor acute or chronic limb ischemia or limb loss. There was no recurrence of local or systemic infection during the follow-up period. Endovascular therapy represents a feasible treatment option for IFAPs in those patients for whom the risk of open surgical repair would be prohibitive, especially under urgent circumstances.},
doi = {10.1007/S00270-016-1527-7},
journal = {Cardiovascular and Interventional Radiology},
number = 4,
volume = 40,
place = {United States},
year = {Sat Apr 15 00:00:00 EDT 2017},
month = {Sat Apr 15 00:00:00 EDT 2017}
}
  • This article describes an endovascular technique of treating an infected pseudoaneurysm by direct thrombin injection via a catheter placed inside the aneurysm sac while maintaining temporary balloon occlusion of the neck of the false aneurysm.
  • We report two cases of acutely infected pseudoaneurysms of the iliac arteries, successfully treated with endovascular stent-grafting. Two patients underwent stent-graft treatment for erosive rupture of the iliac artery caused by surrounding infection. The first case is that of a 61-year-old man who had undergone Miles' operation for an advanced rectal cancer. Postoperatively, he developed intrapelvic abscess formation, from which methicillin-resistant Staphylococcus aureus was cultured, followed by rupture of the right external iliac artery. The second case is that of a 60-year-old man who had a pseudoaneurysm of the left common iliac artery, which was contiguous with a left psoasmore » muscle abscess, from which Streptococcus agalactiae was cultured. Both patients were successfully treated with only a stent-graft and antibiotic therapy, and remained symptom-free 12 months and 10 months later. Although endovascular stent-grafting should not be considered standard therapy for infected aneurysms, our cases suggest that it can result in repair of infected aneurysms even in the uncontrolled active stage.« less
  • We present a very rare case of a life-threatening rupture of a profunda femoral artery distal branch after a Fogarty thrombectomy of a thrombosed crossover synthetic graft between the ipsilateral common femoral artery and a contralateral iliac-popliteal graft; the bleeding profunda femoral artery branch was successfully embolized with metallic coils through the axillary artery approach.
  • The purpose of this study was to demonstrate the use of endovascular technology in the management of peripheral infected aneurysms in high-risk patients as a temporary measure or definitive solution. Five cases underwent successful endovascular stenting of infected aneurysms of the subclavian, femoral, and carotid arteries. All these patients were at high risk for open surgery. Covered stents were placed by percutaneous approach under local anesthesia in all patients. Postoperatively, antibiotics were continued for 3 months. A literature review using the Medline database was also undertaken, and all the relevant papers on endovascular management of peripheral infected aneurysms were takenmore » into account. Stent deployment was successful in all patients. One patient died of mediastinal sepsis and another from type A aortic dissection 5 weeks later. Two patients required drainage of the infected hematoma. Three patients did well at a median follow-up of 1 year, with no evidence of sepsis. A review of the literature shows promising early and midterm results. Most early reports were of single cases, reflecting the low incidence of peripheral infected aneurysms. We conclude that further development of endoluminal techniques and long-term follow-up to establish the durability of stenting could potentially lead to a decrease in the high morbidity and mortality rates associated with infected aneurysmal disease in this high-risk group of patients.« less
  • PurposeTo describe our experiences with treatment of visceral artery pseudoaneurysms (VAPA) by transcatheter coil embolization using an isolation technique and to propose indications for treating VAPA with this method.Materials and MethodsWe treated 37 patients with VAPA endovascularly: There were 15 pancreaticoduodenal arcade, 10 hepatic, 5 renal, 3 splenic, and 1 each left gastric, gastroepiploic, adrenal, and superior mesenteric artery pseudoaneurysms. Preprocedure computed tomography (CT) and/or angiographic studies confirmed the presence of VAPA in all 37 patients. Using the isolation technique, we embolized vessels at sites distal and proximal to the pseudoaneurysm.ResultsTranscatheter coil embolization with the isolation technique was technically successfulmore » in 33 (89%) of 37 patients, and angiogram confirmed the complete disappearance of the VAPA in 32 patients. No major complications occurred during the procedures. In a patient with a pancreaticoduodenal arcade artery pseudoaneurysm, we were unable to control hemorrhage. In 30 of 32 patients who recovered after transcatheter coil embolization using the isolation technique, follow-up CT scan showed no flow in VAPA; they survived without rebleeding. Two of the 32 patients (6%) with confirmed complete disappearance of VAPA on angiogram and CT scan obtained the day after the procedure manifested rebleeding during follow-up.ConclusionTranscatheter coil embolization using the isolation technique is an effective alternative treatment in patients with VAPA. In combination with coil embolization, the isolation technique is particularly useful in patients whose pseudoaneurysms present surgical difficulties.« less