Silver-coated graft as bailout option in managing femoral artery-infected pseudoaneurysm: a review of 30 patients

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.