A Bail Out Solution for an Urgent Situation: Endovascular Exclusion and Embolization of an Infected Femoral Pseudoaneurysm

Abstract

The aim of this study is to show the utility of the combination of thrombin and endograft to solve an urgent situation related to femoral infections. Case: We present the case of a 91-year-old female patient who underwent a femoral endarterectomy and superficial femoral artery angioplasty and developed a surgical site infection. She was readmitted to the hospital because of bleeding and was operated to suture the femoral patch and to do a plasty of sartorius muscle. Six days after the last intervention a femoral pulsatile mass was noted, and the computed tomography showed a big femoral pseudoaneurysm. Taken again to the theater and via a contralateral puncture a viabahn covered endograft was deployed from the external iliac artery to the yet diseased but patent femoral superficial femoral artery and the pseudoaneurysm was punctured, emptied, and filled with thrombin. The patient was discharged 2 weeks after the last procedure and lived for 10 months (she died because of a nonvascular related cause) with a patent graft and with healed lesions. Conclusions: In this case the endovascular solution was a definitive solution in a very old patient with several comorbidities.

Infected femoral artery pseudoaneurysm ligation and revascularisation: A case report

“…Endovascular: embolization, covered stent, stentassisted embolization, or combined options. 8,9 Due to the specificity of the disease and the diversity of management modalities, the appropriate approach should be decided in a multidisciplinary discussion. Hong et al insisted in their publication titled "Femoral Pseudoaneurysm Leading to Necrotizing Fasciitis at the Femoral Arterial Puncture Site" on the essential role of a team approach at an early stage for the meticulous treatment of this rare entity.…”

“…The management of IFAPs is still controversial. It may be divided into three large groups: Radiological: compression with probe associated or not with an injection of thrombin. Surgical: artery ligation, evacuation, bypass, and amputation. Endovascular: embolization, covered stent, stent‐assisted embolization, or combined options 8,9 …”