Silver-coated graft as bailout option in managing femoral artery-infected pseudoaneurysm: a review of 30 patients | ||
| The Egyptian Journal of Surgery | ||
| Article 12, Volume 37, Issue 2, April 2018 PDF (96.33 K) | ||
| DOI: 10.4103/ejs.ejs_7_18 | ||
| Authors | ||
| Ahmed K. Allam; Ahmed K. Gabr; Mohamed Ismail | ||
| Abstract | ||
| Context Femoral artery-infected pseudoaneurysm (fa-IPA) is very common in modern societies, and it represents a difficult problem to the vascular surgeon, as surgical management remains controversial, which ranges from ligation with debridement to extra-anatomical bypass. The present study was carried out to evaluate the outcome of silver-coated grafts used for the management of fa-IPA secondary to illegal drug injections. Aim To assess the outcome of silver-coated graft as bailout revascularization conduit in patients with infected pseudoaneurysm regarding success of the procedure, limb salvage, infection rate, and primary patency rate. Settings and design A prospective study was conducted. Patients and methods The study included 30 patients who presented with fa-IPAs and were admitted to Emergency Department of Benha University Hospital, Ain Shams University Hospitals, and Security Forces Hospital, Makkah, Saudi Arabia, during a 30-month period. Overall, 24 (80%) patients were male and six (20%) patients were female, with age range from 25–46 years. Twenty-one (70%) patients underwent surgical resection and immediate revascularization using silver collagen-coated polyester graft (InterGard Silver; Maquet), whereas nine (30%) patients underwent surgical ligation, with delayed revascularization in four (13.3%) patients through transobturator bypass using the same graft. Results Immediate revascularization using either in situ or extra-anatomic bypass is associated with risk of graft infection [early, five patients of 21 (23.8%); late, two patients of 21 (9.5%), with limb salvage rate of 86.7%]. Conclusion However, no surgical treatment for fa-IPA has been proved to be safe in terms of the overall surgical complications. Our study shows promising results for possibility of using silver-coated grafts as bailout option for limb revascularization. Long-term antimicrobial therapy is advised, and longer follow-up periods are needed to provide accurate results. | ||
| Keywords | ||
| femoral artery; intravenous drug abuse; mycotic aneurysm; pseudoaneurysm; silver-coated grafts | ||
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