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. 2023 Apr 28;9(3):101199.
doi: 10.1016/j.jvscit.2023.101199. eCollection 2023 Sep.

An out of the box treatment for an infected pseudoaneurysm: Deep to superficial femoral artery transposition

Yefim Rabinovich  1 , Leigh Naama Klemperer  1 , Yosef Levi  1 , Chen Rubinstein  1 , Eyal Rosenthal  1 , Basheer Sheick-Yousif  1
Affiliations

An out of the box treatment for an infected pseudoaneurysm: Deep to superficial femoral artery transposition

Yefim Rabinovich et al. J Vasc Surg Cases Innov Tech. .

Abstract

An infected pseudoaneurysm is a condition that has become more common in recent years, with the proliferation of endovascular intervention and the use of intravenous drugs. If left untreated, an infected pseudoaneurysm can progress to rupture, which can lead to life-threatening hemorrhage. No clear consensus has been reached among vascular surgeons regarding the management of infected pseudoaneurysms, and the literature describes a wide range of treatment techniques. In the present report, we describe an "out of the box" approach to infected pseudoaneurysms: a superficial femoral artery to deep femoral artery transposition, as an alternative to ligation with or without bypass reconstruction. We also describe our experience with six patients who underwent this procedure with 100% technical success and limb salvage rates. Although we implemented this technique for cases of infected pseudoaneurysms, we believe it can also be applied to other cases of femoral pseudoaneurysms when angioplasty or graft reconstruction is not feasible. However, further research with larger cohorts is warranted.

Keywords: Femoral reconstruction; IV drug use; Pseudoaneurysm; Vascular infection.

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Figures

Fig 1
Fig 1
Infected pseudoaneurysm (IPSA) presentation before surgery. Note the necrotic ulceration of the skin.
Fig 2
Fig 2
Proposed algorithm for infected pseudoaneurysm (IPSA) management. CFA, Common femoral artery; DFA, deep femoral artery; SFA, superficial femoral artery
Fig 3
Fig 3
Surgical wound after debridement. Arrowhead indicates the common femoral artery (CFA) stump; and arrows, the deep femoral artery (DFA; Right) and superficial femoral artery (SFA; Left) stumps.
Fig 4
Fig 4
After vascular reconstruction. Arrow indicates the deep femoral artery (DFA) to superficial femoral artery (SFA) anastomosis; and arrowhead, the common femoral artery (CFA) stump.
Fig 5
Fig 5
Computed tomography angiogram 3 months after surgery demonstrating collateral flow from the pelvis after deep femoral artery (DFA) to superficial femoral artery (SFA) transposition.
See this image and copyright information in PMC

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