Abstract
Infection of peripheral arterial vascular grafts and stent-grafts represents a complex surgical scenario, with a number of proposed management strategies. Surgical removal of infected material with adjunctive arterial reconstruction is often required. However, surgical removal is often difficult and complex. This case study demonstrates an infected Viabahn stent-graft between the external iliac artery and the superficial femoral artery, with arterial autolysis of the common femoral artery and proximal superficial femoral artery, in which a hybrid technique combining remote endarterectomy and surgical debridement was used to remove the infected stent-graft.
Highlights
Infection of peripheral arterial vascular grafts and stent-grafts represents a complex surgical scenario, with a number of proposed management strategies
The common femoral (CFA) and proximal profunda arteries (PFA) were autolyzed by sepsis, and only the stent-graft remained (Fig 2)
Minn) vascular plug was placed at the proximal end of the previously placed stent graft using a 6-Fr Terumo guide catheter into the proximal right external iliac (EIA) (Fig 3)
Summary
Infection of peripheral arterial vascular grafts and stent-grafts represents a complex surgical scenario, with a number of proposed management strategies. Clinical experience dictates that radical excision of infected material and extra-anatomical bypass in a noninfected field is the treatment of choice.[1,2,3,4] Several other management strategies have been proposed, including in situ vein reconstruction, antibiotic-impregnated grafts, negative pressure wound therapy, and simple ligation.[1,2,3,4] Less extensively investigated are incidents of prosthetic endovascular stent-graft infection, despite their use in managing infected native vessels and grafts.[1,5,6] Utilization of endovascular strategies is attractive given the associated reduction in surgical morbidity and mortality, especially in high-surgical-risk patients.
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