Traumatic nonanastomotic pseudoaneurysm of axillofemoral bypass graft: a case report and review of the literature.
Traumatic nonanastomtic disruption of an axillofemoral bypass graft (AFBG) is a relatively rare entity. However, we are reporting on an 82-year-old female who presented with a pulsating mass on her left side, which was noticed about 2 weeks after she fell on her side. The patient had undergone an ABFG about 15 years earlier for limb revascularization, and she had an occluded aortobifemoral bypass graft. A diagnosis of localized rupture with pseudoaneurysm (PSA) was confirmed with arterial duplex ultrasound and computed tomograph (CT) angiogram scans. A 7-cm PSA with partial disruption of the polytetrafluoroethylene (PTFE) graft at the level of the fifth thoracic vertebrae was noted. An initial work-up to eliminate the possibility of sepsis and localized mycotic seeding was negative. The patient was taken to the hybrid angiogram room, and a percutaneous cut down of the AFBG was performed with local dissection below the site of rupture. A limited angiogram showed a focal PSA of the AFBG. An intravascular ultrasound (IVUS) was performed to calibrate the diameter of the AFBG, and a covered stent was deployed across the area of the disrupted graft. A completion angiogram showed complete exclusion of the PSA with good runoff throughout the graft. The authors will review the management of the traumatic PSA with an endovascular approach.
1Department of Vascular Surgery at Charleston Area Medical Center, Robert C. Byrd Health Sciences Center, Department of Surgery at West Virginia University Charleston, WV, USA.
Albeir Y
AY
Mousa
Aravinda
A
Nanjundappa
Shadi
S
Abu-Halimah
Ali F
AF
Aburahma
D000058:Accidental Falls; D000369:Aged, 80 and over; D017541:Aneurysm, False / Q000175:diagnosis / Q000209:etiology* / Q000601:surgery; D001366:Axillary Artery / Q000601:surgery*; D004210:Dissection; D057510:Endovascular Procedures; D005260:Female; D005263:Femoral Artery / Q000601:surgery*; D006801:Humans; D012086:Reoperation; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D018616:Ultrasonography, Doppler, Duplex; D018084:Ultrasonography, Interventional; D058017:Vascular Grafting / Q000009:adverse effects*; D057772:Vascular System Injuries / Q000175:diagnosis / Q000209:etiology* / Q000601:surgery