Endovascular Treatment for Infected Pseudoaneurysm and Infected Fem-oro-Femoral Bypass Vascular Graft of the Peripheral Artery: A Case Report

Abstract

<p>血管重建、局部清創、感染性植入物的移除與抗生素是傳統感染血管移植物的治療方法。在這裡，我們報告了一名患有第二型糖尿病、血脂異常、冠狀動脈疾病與周邊血管疾病的七十歲男性，對於冠狀動脈疾病他接受過冠狀動脈繞道手術而周邊血管疾病他接受過股動脈至股動脈繞道人工血管支架置放與多次腔內血管治療如雙側髂動脈支架置放與右側股動脈人工血管支架置放，他出現感染性偽動脈瘤與感染性股動脈至股動脈繞道人工血管支架。他的病情不適合替代的繞道人工血管；因此，我們進行腔內人工血管支架的置入以維持下肢有足夠的血流灌注；簡而言之，他在移除感染的血管移植物與隨後的游離皮瓣重建前，接受右髂外動脈到股淺動脈與左髂外動脈到左股膕繞道血管的腔內血管重建，這不是傳統的治療方式。追蹤10年間，病患恢復良好並未復發。因此，對於血管條件較差的患者，這種治療可作為無法進行繞道人工血管手術的替代方法。</p> <p> </p><p>Vascular reconstruction, regional debridement and removal of the infected pros-thesis, and antibiotics are traditional treatment of infected vascular graft. Here, we reported a 70-year-old male with type 2 diabetes mellitus, dyslipidemia, coronary ar-tery disease after coronary artery bypass graft, peripheral artery disease with femoral to femoral (F-F) bypass graft, and multiple endovascular treatment such as bilateral iliac artery stents and right femoral artery stent-graft, who presented with infected pseudoaneurysm and infected F-F bypass graft. His condition was not suitable for alternative bypass graft; hence, endovascular stent-graft was performed to maintain perfusion of lower extremities. In brief, he underwent endovascular revascularization of the right external iliac artery (EIA) to superficial femoral artery, and left EIA to left femoral-popliteal bypass graft before removal of infected graft following free flap reconstruction, which was not a conventional treatment fashion. The patient recovered well with no recurrence after follow-up for 10 years. Therefore, this treatment may be used as an alternative to bypass grafting for patients with poor candidate vessels.</p> <p> </p>