Iliac-femoral stent-graft infection after hybrid procedure redo: Case report

Abstract

Introduction Stent-graft infection in peripheral arteries is rare and potentially dangerous. The use of hybrid procedures, in complicated patients previously treated, involves an increase of infective risk especially in no collaborative patients. Presentation of case We report a case of rare stent-graft infection in a patient treated for a Rutherford IV Multiple Peripheral Arterial Disease (MPAD) involving the right iliac-femoral axis with stenosis on deep femoral artery due to a previously stenting procedure for Superficial Femoral artery (SFA) stenosis. The first simultaneous hybrid intervention consisted of an endovascular iliac stent-graft placement and a surgical common femoral patch angioplasty. After two months the patient was readmitted to our unit for a purulent secretion through a fistulous channel and a suspect infection of stent-graft. Subsequently, the stent-graft was completely removed without possibility to have a surgical revascularization. An amputation major amputation was needed for irreversible ischemia of right leg. Discussion The incidence of stent-graft infection after endovascular aortic aneurysm repair had been reported as 0.4–1.0% while Aortoiliac graft infection occurs in 2–6% of patients. Hybrid procedures are secure and need close follow-up for cases of redo and patient with comorbidities. Conclusions Graft infection is a rare complication after endovascular treatments. Hybrid procedures outcomes are good with less morbidity but in patient with high risk of infection is important a close follow-up.

Brachial artery aneurysm after hemodialysis fistula ligation: Case reports and review of literature

“…About a review of the literature, of the 49 reported cases of brachial artery aneurysm secondary arteriovenous fistula ligation, saphenous vein inverted was used in 21 patients (42.8 %), PTFE prostheses in 9 patients (18.4 %), cephalic vein or basilic vein inverted in 3 patients (6.2 %), other surgeries in 16 patients (32.6 %) ( Table 2 ). In our experience the bypass in PTFE was complicated by an infection probably due to the lack of tissues necessary to protect a graft positioned less deeply than the skin, but in absence of adequate vein grafts for replacement, PTFE is a valid option [ [23] , [24] , [25] , [26] ].…”

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