Endovascular management of infected iliofemoral pseudoaneurysms - a systematic review
Konstantinos G Moulakakis1, Vangelis G Alexiou1,2, George S Sfyroeras1
11 Department of Vascular Surgery, Athens University Medical School, Attikon University Hospital, Athens, Greece.
Abstract:
We conducted a systematic review regarding the efficacy and outcome of endovascular treatment of infected iliofemoral arterial pseudoaneurysms with covered stents. 35 cases were identified, including 5 own. 22 pseudoaneurysms were located in the femoral area and 13 in the iliac vessels. The most commonly reported complaints were pulsatile groin mass (40 %), sepsis (37.1 %), active bleeding (31.4 %), and groin infection with purulent discharge (17.1 %). S. aureus (65.7 %) and Streptococcus species (22.9 %) were the most common microbes isolated. Factors for the development of infected pseudoaneurysms were intravenous drug use (20 %), infection of anastomosis in bypass surgery (22.9 %), cancer (14.3 %), history of multiple hip operations (14.3 %), renal transplantation (2.9 %), and obesity (5.7 %). The most commonly used covered stents were Viabahn (22.9 %),Jostent (17.1 %), Fluency (14.3 %), and Wallgraft (14.3 %). In 15 cases, surgical debridement and/or drainage was also performed.The mean follow-up was 15.8 months. There were only 2 cases of stent graft thrombosis (5.7 %). 2 patients required an open vascular bypass procedure at a later stage. One death was attributed to procedure-related complications (2.9 %). The infection rate of the deployed stent graft in follow-up was 3.4 %. Endovascular exclusion of an infected pseudoaneurysm with primary stent grafting and drainage may be an option in high-risk patients. .
Insights
Endovascular treatment with covered stents shows promise for infected iliofemoral pseudoaneurysms, offering a viable option for high-risk patients with a low complication rate.
Area of Science:
- Vascular Surgery
- Interventional Radiology
- Infectious Diseases
Background:
- Infected iliofemoral pseudoaneurysms are rare but serious conditions.
- Traditional open surgical repair carries significant risks, especially in high-risk patients.
- Endovascular techniques offer a less invasive alternative.
Purpose of the Study:
- To systematically review the efficacy and outcomes of endovascular treatment for infected iliofemoral pseudoaneurysms using covered stents.
- To identify common causative factors, microbial agents, and clinical presentations.
- To evaluate the safety and effectiveness of this endovascular approach.
Main Methods:
- Systematic review of 35 cases (including 5 own cases) of endovascular treatment for infected iliofemoral pseudoaneurysms.
- Analysis of patient demographics, pseudoaneurysm location, presenting symptoms, isolated microbes, and predisposing factors.
- Review of stent types used, adjunctive surgical procedures, follow-up duration, and complication rates.
Main Results:
- Most pseudoaneurysms were femoral (22) or iliac (13).
- Common symptoms included pulsatile groin mass (40%), sepsis (37.1%), and bleeding (31.4%).
- Staphylococcus aureus (65.7%) was the most frequent pathogen. Predisposing factors included IV drug use and prior surgery.
- Low rates of stent graft thrombosis (5.7%) and infection (3.4%) were observed, with one procedure-related death (2.9%).
Conclusions:
- Endovascular exclusion with covered stents and drainage is a feasible option for infected iliofemoral pseudoaneurysms, particularly in high-risk patients.
- The technique demonstrates acceptable safety and efficacy with low complication rates.
- Further research may refine patient selection and optimize treatment protocols.
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