Infected Viabahn Stent Graft in the Superficial Femoral Artery

Abstract

We present a case of an infected stent graft in the superficial femoral artery (SFA). A 67-year-old woman underwent excision of an infected Viabahn stent graft. At exploration there was no apparent artery around the majority of the stent graft, suggesting that the SFA had been autolysed. Infected stents and stent grafts are rare in the SFA position. The risk of infection is likely minimised with standard treatments including drainage of infection prior to stent graft placement and periprocedural antibiotic administration. Successful management will, in most cases, require excision of the stent graft and adjunctive arterial reconstruction, as necessary.

Late Complication after Superficial Femoral Artery (SFA) Aneurysm: Stent-graft Expulsion Outside the Skin

“…The incidence of stent-graft infection after endovascular aortic aneurysm repair had been reported as 0.4-1.0 % [8,9]. Diabetes and smoking independently increase the infection risk; however, other risk factors previously reported for endovascular procedures, such as absence of sterility, lack of antibiotic prophylaxis, introducer sheath permanence more than 24 h, multiple stents implantation, or multiple procedures in the same region [3], were not present in our case. Infected stent and/or stent-graft usually appear as device thrombosis, septic embolization, pseudoaneurysm, and hemorrhage [10].…”

“…Infected stent and/or stent-graft usually appear as device thrombosis, septic embolization, pseudoaneurysm, and hemorrhage [10]. Schneider et al [3] reported a single case of SFA autolysis after Viabahn stent-graft implantation for SFA atherosclerotic disease. The authors advocated the role of malperfusion and foot gangrene as the source of infection.…”

“…Discordant outcomes of endovascular procedures for peripheral artery aneurysm have been reported [1]. A rare complication of superficial femoral artery (SFA) aneurysm endovascular treatment is related to stent and/or stent-graft infection [2][3][4]. We report a unique case of stent-graft infection that was associated with almost complete expulsion of the endovascular device outside the body.…”

Management of a large ruptured popliteal artery aneurysm involving combined deployment of a covered stent graft and evacuation of popliteal fossa hematoma

“…Alternative techniques of repair, such as an interposition vein graft or surgical bypass (also with vein), carry a low risk of infection. However, case reports of infected PTFE stent grafts are very few, [10][11][12] and so in this emergency setting, the endovascular approach was deemed most appropriate, with less infection risk than with surgical bypass or interposition grafting (even with autologous vein conduit). Given that the previously published cases do not describe length of stay or mobility outcomes, it is difficult to compare the efficacy of this treatment.…”

“…There are only three published case reports of PTFE stent graft infections in the lower extremity. [10][11][12] This institution managed a case of a large (6.9 cm in diameter) nonmycotic ruptured PAA, which was successfully treated with endovascular repair using the GORE VIABAHN stent graft and evacuation of popliteal fossa hematoma through a medial distal thigh incision. None of the previously published 11 cases of ruptured PAAs were treated with the combined technique of endovascular intervention and hematoma evacuation.…”