Arterial reconstruction of infected femoral artery pseudoaneurysms using superficial femoral-popliteal vein.
BACKGROUND
Infected femoral artery pseudoaneurysms (IFAPs) secondary to percutaneous arterial access, injection of illegal substances, and from infected synthetic grafts, appear to be increasing in incidence. Ligation of IFAPs without revascularization offers control of infection but may risk limb ischemia. Revascularization with extraanatomic synthetic grafts may risk reinfection and abrupt thrombosis. Excision of IFAPs with revascularization using superficial femoral popliteal vein (SFPV) provides both control of infection and excellent limb perfusion.


METHODS
A retrospective review was conducted of patients diagnosed with IFAP who underwent resection and revascularization with SFPV at a single medical center. Outcomes measured included reinfection and amputation rate. These were compared with other series using various methods to treat IFAPs.


RESULTS
Eleven patients with IFAP were encountered from 1992 to 2004. Mean age was 64 years (+/-10 SD). Five patients developed IFAP secondary to percutaneous arterial access procedures. Four patients developed infected femoral artery pseudoaneurysms secondary to synthetic graft infection. Two patients developed IFAP secondary to injection of illegal substances in the femoral region. All patients had positive wound cultures initially. Staphylococcus was the most common organism found in wound cultures. All patients underwent resection of IFAP with lower extremity revascularization using SFPV. There was no incidence of limb ischemia and no perioperative deaths in this series.


CONCLUSIONS
Excision of IFAP with revascularization can be successfully achieved using SFPV. This method may prove to be superior to other methods with apparent higher patency rates and resistance to reinfection.
Bell
Christopher L
CL
Department of Surgery, The University of Texas Southwestern Medical Center at Dallas, Dallas, TX 75235, USA.
Ali
Ahsan T
AT
Brawley
John G
JG
D'Addio
Victor J
VJ
Modrall
J Gregory
JG
Valentine
R James
RJ
Clagett
G Patrick
GP
D000368:Aged; D000671:Amputation, Surgical; D017541:Aneurysm, False / Q000150:complications / Q000601:surgery*; D001424:Bacterial Infections / Q000150:complications / Q000382:microbiology / Q000601:surgery*; D005260:Female; D005263:Femoral Artery / Q000601:surgery*; D006801:Humans; D007866:Leg / Q000098:blood supply*; D008297:Male; D008875:Middle Aged; D011152:Popliteal Vein / Q000637:transplantation*; D012008:Recurrence; D012189:Retrospective Studies; D013210:Staphylococcus / Q000302:isolation & purification; D013530:Surgical Wound Infection / Q000601:surgery; D014182:Transplantation, Autologous; D016896:Treatment Outcome; D014654:Vascular Patency; D014656:Vascular Surgical Procedures