Stent graft exclusion of a mycotic profunda femoris artery pseudoaneurysm with 2-year follow-up

Bakr, Ahmed; Harding, J.R.; Mahmood, Ansar; Devaraj, S.

doi:10.1136/bcr-2018-229087

Cited by 3 publications

(6 citation statements)

References 16 publications

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“…13,14 Other causes of PFA PSAs include blunt trauma, infections, hip torsion, and IV drug use. [15][16][17][18] Our study highlighted the rarity of PFA PSAs, with six cases presented to our quaternary center over the past 15 years. Prevalence among men and women were roughly equal, reflecting the current literature.…”

Section: Profunda Femoris Artery Pseudoaneurysmsmentioning

confidence: 73%

Vascular surgical management of profunda femoris artery aneurysms: A single center experience

et al. 2022

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Objective Profunda femoris artery aneurysms (PFAAs), which comprise true profunda femoris artery aneurysms (TPFAAs) and profunda femoris artery pseudoaneuryms (PFA PSAs), are rare but clinically significant diseases of the peripheral arterial vasculature. Our aim is to describe our institution’s 15-year experience with PFAAs (TPFAAs and PFA PSAs) to provide insight into patient characteristics, diagnostic imaging modalities, and surgical interventions that contribute to clinically important outcomes in patients with PFAAs. Methods We conducted a retrospective study at our institution using our radiology database. Results We identified six patients with PFA PSAs and four patients with TPFAAs. The clinical presentation of PFA PSAs included a triad of thigh pain, bleeding, and unexplained anemia. There was variety in the aetiologies of PFA PSAs, arising from catheterizations, upper thigh fractures, anastomotic complications, or unknown causes. Most patients with PFA PSAs had hypertension and coronary artery disease, and half of our cohort had peripheral vascular disease. All patients were imaged with duplex ultrasonography (DUS) or computed tomography (CT), the latter being more accurate. All patients with PFA PSAs underwent endovascular treatment, including glue, thrombin, or coil embolization as well as stent-graft insertions. All TPFAAs presented to our center were small and incidentally discovered, explaining the conservative management of our TPFAAs. Two of the four TPFAAs were idiopathic in nature, while one was attributed to post-stenotic dilatation, and another was found in a patient with Ehlers Danlos Syndrome. There was an association between TPFAAs and multiple synchronous or asynchronous aneurysms. Conclusion Pseudoaneurysms of the PFA are mostly iatrogenic in nature and can present with the triad of thigh swelling, bleeding, and unexplained anemia. If the clinical picture is suggestive of a PFA PSA but DUS does not detect a pseudoaneurysm, CT may be added as a more accurate imaging modality. Endovascular embolization is used in smaller pseudoaneurysms and in poor surgical candidates. Multiple glue, coil, or thrombin injections may be required to fully thrombose the pseudoaneurysm sac. True aneurysms of the PFA are associated with synchronous/asynchronous aneurysms and small TPFAAs should be carefully monitored, as there is a risk of enlargement and rupture.

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Section: Profunda Femoris Artery Pseudoaneurysmsmentioning

confidence: 73%

Vascular surgical management of profunda femoris artery aneurysms: A single center experience

et al. 2022

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“…Notably, no reintervention was reported to maintain or restore the patency in these cases, also in those treated for isolate PSA of the profunda femoris artery. 12,[14][15][16][17][18][19][20] The good performance of PFA stent-grafting may be biased by the lack of long-term follow-up on a consistent base: nevertheless, Derom et al 3 reported patency rate at 4 years and similarly, in two cases of our series, we have been able to assess the primary patency rate of the SG at 132 and 144 months. Moreover, the fact that limb salvage was obtained in all patients, it could be a real valuable outcome of interest in these challenging scenarios.…”

Section: Discussionmentioning

confidence: 99%

Outcomes of stent-graft repair for anastomotic femoral pseudoaneurysm. A case series

et al. 2021

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Objective This study aims to report a case series of anastomotic femoral pseudoaneurysms (PSA) treated with stent-grafting (SG) in patients at high-risk for the open surgical approach. Methods It is a retrospective, observational cohort study. Between 1 January 2002 and 1 April 2020, post-hoc analysis of the database including patients who received repair for femoral PSA identified those treated with SG. All but one patient were approached through a contralateral percutaneous transfemoral access, and the SG was always deployed from the common femoral artery to the profunda femoris artery. For this study, primary outcomes of interest were early (≤ 30 days) survival and patency rate. Results We identified 10/823 cases of the entire PSA cohort (1.2%). There were 9 men and 1 woman: the mean age was 76 years ± 9 (range: 64–92). Urgent intervention was performed in 4 patients. The median operative time was 30 min (IQR: 25–36). Access-related complication was never observed. In-hospital mortality occurred in 1 patient due to novel coronavirus-19–related pneumonia. Median follow-up was 24 months (IQR: 12–37); 5 patients died. At the last radiologic follow-up available, all SGs were patent without necessity of reintervention. Conclusion Stent-graft repair for anastomotic femoral PSA may be considered a reasonable alternative for patients at high-risk for open surgical repair.

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“…3 In our literature review only five cases were reported involving PFA being of a mycotic origin with only two being in the modern era (which is defined by the era of widespread use of endovascular treatment modalities) (Table 1). [7][8][9][10][11] With the first case being reported on a postmortem examination of a patient who had IE and leg pain in 1890, by Sir Brice Duckworth where a ruptured PFA aneurysm was found. 12 No established guidelines exist on the management of PFA aneurysms.…”

Section: Discussionmentioning

confidence: 99%

“…Of all the cases reported on PFA MAs only a single recent case was managed using an endovascular approach, with all older cases using an open surgical approach. 4,8,9,10,11 Accordingly, few studies have described endovascular approaches either by stenting or embolization for PFA aneurysms as a whole, in both mycotic and non-MAs. In a recent study performed by Khalid et al In 2014 on a successfully repaired non-mycotic ruptured PFA pseudo-aneurysm using a stent graft similar to our approach, they reported in their review that endo-vascular approach using stent graft was performed on other cases of PFA non-MAs with success and can be an alternative to open surgical approach.…”

Section: Discussionmentioning

confidence: 99%

“…13,16 Endovascular PFA aneurysm repair lacks long-term follow-up on patency and possible stent failure. The only reported PFA MA repaired by endovascular approach 10 the procedure was performed because of previous groin surgery and resulting high surgical risk. A follow-up duplex scan after 2 years revealed complete blockage of the stent graft in the absence of symptoms due to the development of collaterals.…”

Section: Discussionmentioning

confidence: 99%

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Hybrid approach to management for a patient with culture negative infective endocarditis with profunda femoris mycotic pseudoaneurysm: A case report and review of the literature

Alshair,

Baghaffar,

Fatani

et al. 2024

Clinical Case Reports

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Key Clinical MessageMycotic pseudoaneurysms can be a serious and life threatening complication of left sided infective endocarditis. They most commonly affect the major axial vessels. Profunda femoris artery (PFA) aneurysms are rare and present in only 0.5% of all peripheral aneurysms, regardless of the underlying etiology. We present a case of a patient who underwent mitral valve repair for severe mitral regurgitation secondary to culture negative IE which was complicated by multiple mycotic pseudoaneurysm. The PFA pseudoaneurysm which was affected and was complicated with a large hematoma compressing the femoral nerve. This was managed by a staged hybrid approach. Endovascular stenting was performed first to seal the pseudoaneurysm and facilitate open surgical repair using a reversed interposition saphenous vein graft. To the best of our knowledge, this is the first reported case of a PFA mycotic aneurysm (MA) being managed by a hybrid approach using endo‐vascular and open surgical repair. MAs and pseudoaneurysms are complex and life threatening conditions requiring meticulous planning for optimal management. Endovascular stenting can be considered as an alternative to surgical management in certain cases or as a bridge to definitive open surgical repair depending on anatomical location and associated complications.

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Stent graft exclusion of a mycotic profunda femoris artery pseudoaneurysm with 2-year follow-up

Cited by 3 publications

References 16 publications

Vascular surgical management of profunda femoris artery aneurysms: A single center experience

Vascular surgical management of profunda femoris artery aneurysms: A single center experience

Outcomes of stent-graft repair for anastomotic femoral pseudoaneurysm. A case series

Hybrid approach to management for a patient with culture negative infective endocarditis with profunda femoris mycotic pseudoaneurysm: A case report and review of the literature

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