Percutaneous balloon catheter vascular control for infected axillary artery pseudoaneurysm

The treatment of choice for the septic aortic prosthesis remains graft excision and extra-anatomic revascularization usually with axillofemoral bypass. Several recent retrospective series report secondary graft infection rates in these remedial procedures that range from 5-10%. In this setting, proximal axillary artery anastomotic disruption with pseudoaneurysm formation poses an especially vexing problem for the surgeon. We report a case of secondary graft infection presenting as unusually large, perianastomotic pseudoaneurysm formation. Our desire to avoid thoracotomy and the potential intrathoracic spread of infection prompted us to achieve proximal control by endovascular means. Balloon occlusion of the axillary artery proximal and distal to the graft anastomosis was achieved angiographically by percutaneous puncture of the ipsilateral brachial artery at two separate sites. This facilitated prompt removal of the infected graft with minimal intraoperative blood loss. Our favorable experience with this approach suggests a role for its more general application in the management of infected perianastomotic pseudoaneurysm.