Endovascular stenting of peripheral infected aneurysms: a temporary measure or a definitive solution in high-risk patients.
The purpose of this study was to demonstrate the use of endovascular technology in the management of peripheral infected aneurysms in high-risk patients as a temporary measure or definitive solution. Five cases underwent successful endovascular stenting of infected aneurysms of the subclavian, femoral, and carotid arteries. All these patients were at high risk for open surgery. Covered stents were placed by percutaneous approach under local anesthesia in all patients. Postoperatively, antibiotics were continued for 3 months. A literature review using the Medline database was also undertaken, and all the relevant papers on endovascular management of peripheral infected aneurysms were taken into account. Stent deployment was successful in all patients. One patient died of mediastinal sepsis and another from type A aortic dissection 5 weeks later. Two patients required drainage of the infected hematoma. Three patients did well at a median follow-up of 1 year, with no evidence of sepsis. A review of the literature shows promising early and midterm results. Most early reports were of single cases, reflecting the low incidence of peripheral infected aneurysms. We conclude that further development of endoluminal techniques and long-term follow-up to establish the durability of stenting could potentially lead to a decrease in the high morbidity and mortality rates associated with infected aneurysmal disease in this high-risk group of patients.
Vascular Secretaries Office, Waller Cardiac Building, St Mary's Hospital, Praed Street, London W2 1NY, UK. c.riga@imperial.ac.uk
Celia
C
Riga
Colin
C
Bicknell
Ravul
R
Jindal
Nicholas
N
Cheshire
Mohamad
M
Hamady
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000785:Aneurysm, Infected / Q000000981:diagnostic imaging / Q000382:microbiology / Q000628:therapy*; D000792:Angiography; D002339:Carotid Arteries; D017809:Fatal Outcome; D005260:Female; D005263:Femoral Artery; D006801:Humans; D008297:Male; D008875:Middle Aged; D012306:Risk; D015607:Stents; D013348:Subclavian Artery; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome