Early stent fractures in superficial femoral artery resulting multiple pseudoaneurysm formation within one year: a case report

Abstract

Background: Though fracture is known complication of stenting, pseudoaneurysm asscoiated with stent fracture is an extremely rare complication. This has previoulsy been described to occur at least one or more years following initial stent placement. Here we present a case of multi-site stent fracture leading to two separate SFA pseudoaneurysms within one year of placement, successfully treated with covered stents.

Case presentation: A 72-year-old male presented with severe claudication of his left lower extremity (Rutherford 3), found to have long segment SFA chronic total occlusion (CTO). Patient successfully underwent endovascular revascularization. Follow-up duplex ultrasound (US) at one year demonstrated a focus of severe in-stent restenosis (ISR). During repeat angiogram for treatment of the stenosis, stent fracture and pseudoaneurysm was seen in the distal SFA, which was treated successfully with a self-expanding covered stent. Additional stent fractures and pseudoanerusyms were subseuqently identified on follow-up, necessitating a third angiogram, and these were successfully repaired using overlapping covered stents, without further recurrence.

Conclusions: Superficial femoral artery stent fractures leading to pseudoaneurysms are extremely rare, particularly within first year of stent placement. Endovascular repair with covered stents has proven to be an effective treatment option with decreased procedural morbidity compared to surgical repair.

Keywords: Endovascular management; Everflex stent; Intravascular ultrasound; Stent fracture; Superficial femoral artery pseudoaneurysm; Viabahn covered stent.

Fig. 1

Initial angiogram pre- and post-intervention demonstrating SFA CTO (star) successful recanalization with stenting (arrow) (a, b)

Fig. 2

Angiogram 12 months after initial intervention demonstrating focal ISR (thin arrow) in proximal SFA with a distal SFA pseudoaneurysm (thick arrow) (a, b), treated with angioplasty proximally and Viabahn covered stent placement distally (c, d)

Fig. 3

1 month follow-up US following intervention now demonstrating large pseudoaneurysm (star) surrounding the SFA extending to the ostium (a, b), with corresponding intraprocedural intravascular ultrasound during 3rd angiogram demonstrating large, type II stent fracture (solid arrow) in proximal SFA with flow into large surrounding pseudoaneurysm (c)

Fig. 4

3rd angiogram demonstrating interval development of patent component of proximal SFA pseudoaneurysm (solid arrow) (a), successfully treated with placement of Viabahn covered stents to exclude the pseudoaneurysm (b)