Symptomatic superficial femoral artery pseudoaneurysm due to late stent fracture

Early stent fractures in superficial femoral artery resulting multiple pseudoaneurysm formation within one year: a case report

BACKGROUND

Though fracture is known complication of stenting, pseudoaneurysm asscoiated with stent fracture is an extremely rare complication. This has previoulsy been described to occur at least one or more years following initial stent placement. Here we present a case of multi-site stent fracture leading to two separate SFA pseudoaneurysms within one year of placement, successfully treated with covered stents.

CASE PRESENTATION

A 72-year-old male presented with severe claudication of his left lower extremity (Rutherford 3), found to have long segment SFA chronic total occlusion (CTO). Patient successfully underwent endovascular revascularization. Follow-up duplex ultrasound (US) at one year demonstrated a focus of severe in-stent restenosis (ISR). During repeat angiogram for treatment of the stenosis, stent fracture and pseudoaneurysm was seen in the distal SFA, which was treated successfully with a self-expanding covered stent. Additional stent fractures and pseudoanerusyms were subseuqently identified on follow-up, necessitating a third angiogram, and these were successfully repaired using overlapping covered stents, without further recurrence.

CONCLUSIONS

Superficial femoral artery stent fractures leading to pseudoaneurysms are extremely rare, particularly within first year of stent placement. Endovascular repair with covered stents has proven to be an effective treatment option with decreased procedural morbidity compared to surgical repair.

Hybrid surgery techniques for the treatment of in-stent restenosis after 5 years of femoral artery self-expanding bare-metal stent implantation: A case report

RATIONALE

Lower extremity arteriosclerosis obliterans (ASO) disease is caused by the formation of atherosclerotic plaque in the femoral artery, which causes the stenosis and occlusion of lower legs, and then leads to chronic limb ischemia. Stent intervention is the most common treatment for ASO in the lower extremities, although there is a risk of overstretching or fracturing the stent, resulting in stent rupture. We provide a unique method for treating stent rupture.

PATIENT CONCERNS

A 79-year-old male presented with intermittent claudication of the left lower limb for 6 months. Five years ago, a stent was placed in the lower extremity femoral artery. According to the examination, the stent suffered a modest torsional fracture.

DIAGNOSIS

The case was diagnosed with lower extremity ASO.

INTERVENTIONS

We performed a combination of femoral endarterectomy and interventional surgery.

OUTCOMES

Blood flow was restored after the hybrid operation has been used to treat arterial stenosis in the lower limbs.

CONCLUSION

Integrating vascular interventional surgeries can shorten surgical procedures time and increase success rates.

Late Vascular Injury at Both Edges of the VIABAHN Stent Graft after Endovascular Repair for Idiopathic Superficial Femoral Artery Rupture

The VIABAHN stent graft is often used for traumatic and iatrogenic vascular injuries. In this case, vascular injury at both edges of the VIABAHN stent graft was noted 4 months after endovascular repair for idiopathic superficial femoral artery (SFA) rupture. The longitudinal compression of the SFA with a decrease in hematoma size was assumed to exceed the flexibility of the stent graft. Thus, the use of stent grafts for vascular injuries with giant pseudoaneurysms may result in late vascular injuries at both edges of the stent graft. Therefore, cautious assessment of its indications and strict surveillance are required.

Endovascular embolization of a lower limb arteriovenous fistula using a vascular plug deployed with a through-and-through arteriovenous access

A 66-year-old man was referred to our institution for a popliteal arteriovenous fistula (AVF). The patient presented with left lower limb edema associated with a pulsatile popliteal mass with bruit at auscultation, and no sign of lower limb ischemia. Relevant history included penetrating stabbing wound to that leg 50 years prior. A computed tomography scan demonstrated an AVF with a tract 10 mm in length and 6 mm in diameter at the level of the popliteal fossa. An AMPLATZER Vascular Plug III 12 mm (AVP - AGA Medical Corporation, Minneapolis, MN) was initially deployed through a percutaneous femoral arterial access. Initial angiographic check showed inadequate sealing, so the plug was repositioned from the venous side of the AVF with a through-and-through arteriovenous access from the posterior tibial vein, achieving a correct sealing. At 24-month follow-up the patient does not present any complications from the procedure, and the AVF remains occluded.

Superficial Femoral Artery Pseudoaneurysm and Arterial Wall Destruction After Drug-Coated Balloon Treatment

Drug-coated balloon angioplasty may present an efficient alternative to traditional balloon angioplasty and stenting, which suffer from high rates of restenosis and increased risk of stent fractures in the anatomically unfavorable regions, such as the superficial femoral artery in the adductor canal. Although pseudoaneurysms are the most common vascular access site complications, they are considerably rarer at the site of the endovascular treatment. They can be caused by several mechanisms, including stent fractures, usage of oversized balloons, high-pressure inflations, and infections. In addition, paclitaxel, the drug released from drug-coated balloons, may also play a significant role in the formation and exacerbation of pseudoaneurysms. The exact pathophysiology remains unclear, but it may be due to a combination of paclitaxel's suppression of neointimal healing and immune response, cytotoxic properties, and hypersensitivity-related inflammation.