Background: Rupture of infected anastomotic femoral artery
pseudoaneurysms (AFAPs) represents a limb and life-threatening condition
requiring emergency intervention. This study aimed to evaluate the
feasibility, safety, and efficacy of a hybrid repair for ruptured
infected AFAPs consisted of percutaneous stent-graft deployment and
second-stage surgical debridement.
Methods: Between October 2004 and January 2008, 6 patients (3 female,
mean age 65.8 +/- 11.4 years) with ruptured infected AFAPs were treated
with emergent percutaneous stent-graft implantation and secondary
surgical debridement. Three patients had undergone a femoro-popliteal
and 1 a femoro-tibial bypass for peripheral arterial disease, while 2
patients had a femoral arteriovenous graft (AVG) for hemodialysis access
due to chronic renal failure. Four pseudoaneurysms were located at the
common femoral artery (CFA) and 2 involved the superficial femoral
artery (SFA). Mean pseudoaneurysm diameter was 6.8 +/- 0.9 mm (range,
5.4-7.8 mm). The mean interval between the initial operation and
presentation to our department was 26.7 +/- 14.5 months (range, 7-50
months). All patients suffered from severe comorbidities and were judged
unfit for major surgery under general anesthesia.
Results: All patients were successfully managed by urgent percutaneous
deployment of covered stents at the site of the arterial deficit.
Extensive surgical debridement along with pseudoaneurysm excision was
accomplished successfully in all 6 patients 1-3 days after stent-graft
placement under local anesthesia, without the need for extended vessel
exposure for proximal and distal control. No death occurred within 30
days after stent-graft implantation. During follow-up, (mean 14.1 +/-
8.2 months, range, 6 to 25 months) all stent-grafts remained patent
without endoleak, while no signs of recurrent local or systemic
infection were noticed. Two patients died at 8 and 10 months after the
procedure due to heart failure complications and acute myocardial
infarction, respectively.
Conclusion: Emergency stent-graft deployment, followed by secondary
surgical debridement and long-term antimicrobial therapy is a viable
alternative for ruptured infected AFAPs. Especially for patients unfit
for major surgery, it may be the most favorable treatment option. (J
Vasc Surg 2009;49:938-45.