Document Detail


Hybrid repair of ruptured infected anastomotic femoral pseudoaneurysms: Emergent stent-graft implantation and secondary surgical debridement.
MedLine Citation:
PMID:  19147320     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
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.
Authors:
Chris Klonaris; Athanasios Katsargyris; Ioanna Vasileiou; Fotios Markatis; Christos D Liapis; Elias Bastounis
Publication Detail:
Type:  Journal Article     Date:  2009-01-14
Journal Detail:
Title:  Journal of vascular surgery     Volume:  49     ISSN:  1097-6809     ISO Abbreviation:  J. Vasc. Surg.     Publication Date:  2009 Apr 
Date Detail:
Created Date:  2009-04-03     Completed Date:  2009-04-20     Revised Date:  2012-10-03    
Medline Journal Info:
Nlm Unique ID:  8407742     Medline TA:  J Vasc Surg     Country:  United States    
Other Details:
Languages:  eng     Pagination:  938-45     Citation Subset:  IM    
Affiliation:
First Department of Surgery, Vascular Division, "LAIKON" Hospital, Athens University Medical School, Athens, Greece.
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MeSH Terms
Descriptor/Qualifier:
Aged
Anastomosis, Surgical / adverse effects
Aneurysm, False / etiology,  pathology,  surgery*
Aneurysm, Infected / etiology,  pathology,  surgery*
Aneurysm, Ruptured / etiology,  pathology,  surgery*
Angiography, Digital Subtraction
Anti-Infective Agents / therapeutic use
Arteriovenous Shunt, Surgical / adverse effects
Blood Vessel Prosthesis*
Blood Vessel Prosthesis Implantation / adverse effects,  instrumentation*
Debridement*
Feasibility Studies
Female
Femoral Artery / pathology,  surgery*
Humans
Male
Middle Aged
Peripheral Vascular Diseases / surgery
Renal Dialysis
Reoperation
Retrospective Studies
Stents*
Treatment Outcome
Chemical
Reg. No./Substance:
0/Anti-Infective Agents

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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