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Alexandre K. Endovascular Management of a Large Femoral Pseudoaneurysm: A Case Report and Literary Review. Cureus 2022; 14:e23045. [PMID: 35464529 PMCID: PMC9001809 DOI: 10.7759/cureus.23045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/10/2022] [Indexed: 11/05/2022] Open
Abstract
Femoral artery pseudoaneurysms have an increased incidence over the past few years due to the rise in percutaneous catheterization and so have the potential treatment options. Ultrasound-guided thrombin injection has been strongly studied, and data have shown its efficacy, safety, and superiority to ultrasound-guided compression therapy as well as open surgical repair; however, a less well-studied approach that appears to be burgeoning is endovascular stent repair. Many small studies and case reports have shown this option to be not only effective but also safe and might be the treatment option of choice in patients who are deemed high risk for surgical intervention or with complicated anatomical considerations at the site of injury. In this case report, we describe a 71-year-old man with an expanding right groin hematoma which was discovered to be a right superficial femoral artery pseudoaneurysm with a venous fistula connection to the common femoral vein. Due to the patient’s venous fistula component, high surgical risk from substantial comorbidities, and large pseudoaneurysm size with a wide pseudoaneurysm neck, thrombin injection, compression therapy, and open surgical repair were ruled out as potential treatments; therefore, endovascular stent repair was performed. The procedure was successful, as was the patient’s postoperative period. This case report and literary review can support and further validate the usage of endovascular stent repair to treat femoral artery pseudoaneurysms.
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Franchin M, Fontana F, Luzzani L, Lanza M, Piffaretti G, Bellosta R. Outcomes of stent-graft repair for anastomotic femoral pseudoaneurysm. A case series. Vascular 2021; 30:1088-1096. [PMID: 34559031 DOI: 10.1177/17085381211045194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE This study aims to report a case series of anastomotic femoral pseudoaneurysms (PSA) treated with stent-grafting (SG) in patients at high-risk for the open surgical approach. METHODS It is a retrospective, observational cohort study. Between 1 January 2002 and 1 April 2020, post-hoc analysis of the database including patients who received repair for femoral PSA identified those treated with SG. All but one patient were approached through a contralateral percutaneous transfemoral access, and the SG was always deployed from the common femoral artery to the profunda femoris artery. For this study, primary outcomes of interest were early (≤ 30 days) survival and patency rate. RESULTS We identified 10/823 cases of the entire PSA cohort (1.2%). There were 9 men and 1 woman: the mean age was 76 years ± 9 (range: 64-92). Urgent intervention was performed in 4 patients. The median operative time was 30 min (IQR: 25-36). Access-related complication was never observed. In-hospital mortality occurred in 1 patient due to novel coronavirus-19-related pneumonia. Median follow-up was 24 months (IQR: 12-37); 5 patients died. At the last radiologic follow-up available, all SGs were patent without necessity of reintervention. CONCLUSION Stent-graft repair for anastomotic femoral PSA may be considered a reasonable alternative for patients at high-risk for open surgical repair.
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Affiliation(s)
- Marco Franchin
- Vascular Surgery, Department of Medicine and Surgery, University of Insubria School of Medicine, ASST Settelaghi Universitary Teaching Hospital, Varese, Italy
| | - Federico Fontana
- Interventional Radiology, Department of Medicine and Surgery, University of Insubria School of Medicine, ASST Settelaghi Universitary Teaching Hospital, Varese, Italy
| | - Luca Luzzani
- Vascular Surgery, Cardiovascular Department, Poliambulanza Foundation Teaching Hospital, Brescia, Italy
| | - Michela Lanza
- Vascular Surgery, Department of Medicine and Surgery, University of Insubria School of Medicine, ASST Settelaghi Universitary Teaching Hospital, Varese, Italy
| | - Gabriele Piffaretti
- Vascular Surgery, Department of Medicine and Surgery, University of Insubria School of Medicine, ASST Settelaghi Universitary Teaching Hospital, Varese, Italy
| | - Raffaello Bellosta
- Vascular Surgery, Cardiovascular Department, Poliambulanza Foundation Teaching Hospital, Brescia, Italy
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Imran JB, Tsai S, Timaran CH, Valentine RJ, Modrall JG. Damage Control Endografting for the Unstable or Unfit Patient. Ann Vasc Surg 2017; 42:150-155. [PMID: 28242397 DOI: 10.1016/j.avsg.2016.10.034] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2016] [Revised: 10/07/2016] [Accepted: 10/12/2016] [Indexed: 11/25/2022]
Abstract
BACKGROUND In the elective setting, both open surgical and endovascular therapies may be reasonable treatment options for many vascular conditions. However, an unstable or unfit patient with a vascular emergency may be less able to tolerate a definitive open vascular operation. We now report the outcomes for "damage control" endografting for unstable or unfit patients with vascular emergencies as bridge therapy before definitive open therapy. METHODS A retrospective review of patients who underwent damage control endografting over a 9-year period (2005-2014) was performed. The primary inclusion criterion was the use of emergency damage control endografting as temporizing therapy to permit time for patient stabilization or optimization before definitive open repair. Patients who underwent endografting as planned definitive therapy were excluded. RESULTS Indications for damage control endografting included arterial bleeding or expanding hematoma related to infected pseudoaneurysms (n = 5), infected grafts (n = 3), or cancer (n = 1). Anatomic locations included the aorta (n = 3), common iliac artery (n = 2), common femoral artery (n = 2), common carotid artery (n = 1), and subclavian artery (n = 1). The median age was 56 years (interquartile range [IQR] 51-70). Five of our patients were male and 4 patients were female. Median follow-up was 8 months (IQR 3-11). Operative (30-day) mortality was 11%. A single patient died on postoperative day 12 after undergoing aortic and duodenal reconstruction related to an aortoenteric fistula. Using the damage control approach, clinical stabilization was achieved in 8 of the 9 patients (88%). One patient with a bleeding infected common femoral artery pseudoaneurysm continued to bleed and required emergent open surgical repair. Definitive open repair was completed in 8 of the 9 patients (88%) at a median time interval of 3 days (IQR 1-10). Planned open repair was not performed in a patient with exsanguinating carotid hemorrhage after the associated cancer was deemed unresectable. CONCLUSIONS Damage control endografting facilitates stabilization of the majority of unstable and unfit patients with vascular emergencies to allow definitive open repair under more favorable conditions. This technique should be employed rarely due to the expense, but it is a technique worthy of consideration in select patients.
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Affiliation(s)
- Jonathan B Imran
- Division of Vascular and Endovascular Surgery, Department of Surgery, University of Texas Southwestern Medical Center and Dallas Veterans Affairs Medical Center, Dallas, TX
| | - Shirling Tsai
- Division of Vascular and Endovascular Surgery, Department of Surgery, University of Texas Southwestern Medical Center and Dallas Veterans Affairs Medical Center, Dallas, TX
| | - Carlos H Timaran
- Division of Vascular and Endovascular Surgery, Department of Surgery, University of Texas Southwestern Medical Center and Dallas Veterans Affairs Medical Center, Dallas, TX
| | | | - John Gregory Modrall
- Division of Vascular and Endovascular Surgery, Department of Surgery, University of Texas Southwestern Medical Center and Dallas Veterans Affairs Medical Center, Dallas, TX.
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Endovascular Management of Infected Femoral Artery Pseudoaneurysms in High-Risk Patients: A Case Series. Cardiovasc Intervent Radiol 2016; 40:616-620. [DOI: 10.1007/s00270-016-1527-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2016] [Accepted: 12/01/2016] [Indexed: 10/20/2022]
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Moulakakis KG, Sfyroeras GS, Alexiou VG, Kakisis J, Lazaris A, Vasdekis SN, Brountzos EN, Geroulakos G. Endovascular Management of Infected Iliofemoral Pseudoaneurysms. Vasc Endovascular Surg 2016; 50:421-6. [DOI: 10.1177/1538574416655895] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The treatment of infected iliofemoral pseudoaneurysms is challenging and controversial. We present our experience regarding the efficacy and outcome of endovascular treatment of infected iliofemoral arterial pseudoaneurysms with covered stents. Our experience with 5 cases showed that stent grafting combined with antibiotic therapy and provisional drainage may be a safe and effective option in patients with cancer, patients with history of multiple hip revisions, and drug-addicted users. In our small case series, the reinfection rate was null and no covered stent thrombosis occurred. These results are fairly encouraging, but further studies with longer follow-up in a larger number of patients are needed to confirm the efficacy and durability of the technique.
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Affiliation(s)
- Konstantinos G. Moulakakis
- Department of Vascular Surgery, Athens University Medical School, Attikon University Hospital, Athens, Greece
| | - George S. Sfyroeras
- Department of Vascular Surgery, Athens University Medical School, Attikon University Hospital, Athens, Greece
| | - Vangelis G. Alexiou
- Department of Vascular Surgery, Athens University Medical School, Attikon University Hospital, Athens, Greece
- Alfa Institute of Biomedical Sciences (AIBS), Athens, Greece
| | - John Kakisis
- Department of Vascular Surgery, Athens University Medical School, Attikon University Hospital, Athens, Greece
| | - Andreas Lazaris
- Department of Vascular Surgery, Athens University Medical School, Attikon University Hospital, Athens, Greece
| | - Spyridon N. Vasdekis
- Department of Vascular Surgery, Athens University Medical School, Attikon University Hospital, Athens, Greece
| | - Elias N. Brountzos
- Department of Radiology, Athens University Medical School, Attikon University Hospital, Athens, Greece
| | - George Geroulakos
- Department of Vascular Surgery, Athens University Medical School, Attikon University Hospital, Athens, Greece
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Boieru R, Georg Y, Ramlugun D, Martinot M, Camin A, Matysiak L, Kretz B. Endovascular Treatment of Infected Brachial Pseudoaneurysm in an Intravenous Drug Abuser: A Case Report. Ann Vasc Surg 2015; 29:1449.e13-6. [PMID: 26142880 DOI: 10.1016/j.avsg.2015.04.061] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2014] [Revised: 03/25/2015] [Accepted: 04/06/2015] [Indexed: 11/19/2022]
Abstract
We report the case of a 36-year-old male, admitted in the emergency room with a nonruptured brachial pseudoaneurysm after buprenorphine injection, with no signs of distal acute ischemia. After endovascular treatment with a nitinol covered stent associated with adapted antibiotherapy and 35 days of hospitalizations, the patient was discharged with good short results but stent need to be removed at 6 months for thrombosis and partial exposure through the wound.
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Affiliation(s)
- Raluca Boieru
- Service de Chirurgie Vasculaire, Hôpital Pasteur, Colmar, France
| | - Yannick Georg
- Service de Chirurgie Vasculaire et de Transplantation Rénale, Nouvel Hôpital Civil, Strasbourg, France
| | | | - Martin Martinot
- Service des Maladies Infectieuses, Hôpital Pasteur, Colmar, France
| | - Amelie Camin
- Service de Chirurgie Vasculaire, Hôpital Pasteur, Colmar, France
| | - Lucien Matysiak
- Service de Chirurgie Vasculaire, Hôpital Pasteur, Colmar, France
| | - Benjamin Kretz
- Service de Chirurgie Vasculaire, Hôpital Pasteur, Colmar, France.
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Behera C, Naagar S, Krishna K, Taraporewalla DR, Garudadhri G, Prasad K. Sudden death due to ruptured pseudoaneurysm of femoral artery in injected drug abusers – Report of four cases at autopsy and review of literature. J Forensic Leg Med 2014; 22:107-11. [DOI: 10.1016/j.jflm.2013.12.010] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2013] [Accepted: 12/07/2013] [Indexed: 10/25/2022]
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Management of a complicated ruptured infected pseudoaneurysm of the femoral artery in a drug addict. Case Rep Vasc Med 2012; 2012:434768. [PMID: 23227421 PMCID: PMC3514812 DOI: 10.1155/2012/434768] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2012] [Accepted: 11/06/2012] [Indexed: 11/18/2022] Open
Abstract
Infected pseudoaneurysm of the femoral artery represents a devastating complication of intravenous drug abuse, especially in the event of rupture. Operative strategy depends upon the extent of arterial injury and the coexistence of infection or sepsis. Options range from simple common femoral artery (CFA) ligation to complex arterial reconstruction with autologous grafts (arterial, venous, or homografts). We report herein the management of a 29-year-old male patient who was urgently admitted with a ruptured pseudoaneurysm of the right CFA, extending well above the inguinal ligament. Multidisciplinary approach with multiple arterial reconstructions and subsequent coverage of the tissue defect with a rectus abdominis musculocutaneous flap transposition was performed.
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Jayaraman S, Richardson D, Conrad M, Eichler C, Schecter W. Mycotic Pseudoaneurysms Due to Injection Drug Use: A Ten-Year Experience. Ann Vasc Surg 2012; 26:819-24. [DOI: 10.1016/j.avsg.2011.11.031] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2011] [Revised: 11/16/2011] [Accepted: 11/20/2011] [Indexed: 11/25/2022]
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Orimoto Y, van Keulen JW, Waasdorp EJ, Moll FL, van Herwaarden JA. Treatment of a recurrent false aneurysm of the femoral artery by stent--graft placement from the brachial artery. Ann Vasc Surg 2011; 25:841.e1-4. [PMID: 21620657 DOI: 10.1016/j.avsg.2011.01.010] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2010] [Revised: 01/21/2011] [Accepted: 01/24/2011] [Indexed: 11/28/2022]
Abstract
An anastomotic false aneurysm is a well known complication after femoral artery surgery. Open surgical repair is the treatment of choice for anastomotic femoral aneurysms, but this can be challenging, unsuccessful, or even impossible. Endovascular repair is an alternative in these cases, but the delivery of a stent--graft in the femoral artery can be difficult. We report the case of a patient with a recurrent left femoral artery anastomotic false aneurysm, treated twice by open exclusion, and finally excluded successfully by a stent--graft that was inserted through the left brachial artery.
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Affiliation(s)
- Yuki Orimoto
- Department of Vascular Surgery, University Medical Center, Utrecht, The Netherlands
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Pellenc Q, Capdevila C, Julia P, Fabiani JN. Ruptured popliteal artery pseudoaneurysm complicating a femoral osteochondroma in a young patient. J Vasc Surg 2011; 55:1164-5. [PMID: 21459549 DOI: 10.1016/j.jvs.2011.01.060] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2010] [Revised: 12/29/2010] [Accepted: 01/23/2011] [Indexed: 11/30/2022]
Affiliation(s)
- Quentin Pellenc
- Department of Cardio-Vascular Surgery, Hôpital Européen Georges Pompidou, Université Paris Descartes, Paris, France.
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Emergency endovascular treatment of early spontaneous nonaneurysmal popliteal artery rupture in a patient with Salmonella bacteremia. J Vasc Surg 2010; 52:751-7. [DOI: 10.1016/j.jvs.2010.04.031] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2010] [Revised: 04/14/2010] [Accepted: 04/14/2010] [Indexed: 11/24/2022]
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Antonopoulos C, Karagianni M, Galanakis N, Vagianos C. Mycotic Splenic Artery Aneurysm Secondary to Coxiella burnetii Endocarditis. Ann Vasc Surg 2010; 24:416.e13-6. [DOI: 10.1016/j.avsg.2009.05.018] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2009] [Accepted: 05/27/2009] [Indexed: 10/20/2022]
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Klonaris C, Katsargyris A, Vasileiou I, Markatis F, Liapis CD, Bastounis E. Hybrid repair of ruptured infected anastomotic femoral pseudoaneurysms: Emergent stent-graft implantation and secondary surgical debridement. J Vasc Surg 2009; 49:938-45. [DOI: 10.1016/j.jvs.2008.10.063] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2008] [Revised: 10/28/2008] [Accepted: 10/30/2008] [Indexed: 10/21/2022]
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Sadat U, Kullar PJ, Noorani A, Gillard JH, Cooper DG, Boyle JR. Emergency endovascular management of peripheral artery aneurysms and pseudoaneurysms - a review. World J Emerg Surg 2008; 3:22. [PMID: 18644114 PMCID: PMC2494545 DOI: 10.1186/1749-7922-3-22] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2008] [Accepted: 07/21/2008] [Indexed: 11/14/2022] Open
Abstract
Endovascular stenting has been successfully employed in the management of aortic aneurysms; however, its use in managing peripheral arterial conditions remains questionable. We review the utility of endovascular technique in the management of peripheral arterial conditions like aneurysms, pseudoaneurysms and arterio-venous fistulas in the emergency setting. Though long term data about graft patency rates is not yet available, the endovascular approach appears to be a useful minimally invasive technique in situations where open repair is either difficult or not feasible.
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Affiliation(s)
- Umar Sadat
- Cambridge Vascular Unit, Cambridge University Hospitals NHS Foundation Trust, UK.
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