# Hybrid Repair of Infected Femoral Artery Pseudoaneurysm: Stent Graft Placement and Artificial Graft Replacement

## TL;DR

A 70-year-old cancer patient with an infected femoral artery pseudoaneurysm was successfully treated with a hybrid procedure combining stent graft placement and artificial graft replacement.

## Contribution

The paper presents a novel hybrid surgical approach for managing infected pseudoaneurysms in patients who cannot tolerate more invasive procedures.

## Key findings

- The hybrid treatment effectively controlled the infected pseudoaneurysm in a patient with a history of cancer.
- The procedure avoided a highly invasive abdominal surgery, resulting in a favorable postoperative recovery.
- Antibiotic therapy alone was insufficient, but combined with hybrid surgery, it led to successful infection control.

## Abstract

A femoral artery pseudoaneurysm is the most prevalent complication of femoral access due to the artery's accessibility and frequent use for catheterization and blood tests. An infected femoral artery pseudoaneurysm is often life-threatening and challenging to manage. A 70-year-old male with a history of tongue cancer treatments, including resection, lymph node dissection, and radiation chemotherapy, visited his previous physician for a fever and was prescribed oral antibiotics, but the fever persisted, accompanied by pain and a mass in the left groin. An enhanced CT revealed an infected pseudoaneurysm of the left femoral artery. The fever's etiology was unclear but likely stemmed from a blood draw from the femoral artery during a prior visit, resulting in a pseudoaneurysm that became infected. The patient was transferred to our hospital due to management challenges. Blood cultures from the previous hospital were positive, and laboratory tests indicated an active infection. The initial strategy was to continue antibiotic therapy to control the infection. After approximately a month of antibiotic treatment, blood cultures remained negative, and laboratory results improved significantly. However, the aneurysm had clearly enlarged, necessitating emergency surgery. Typically, surgical intervention requires opening the abdomen to replace the external iliac artery to its extent, a considerably invasive procedure for the patient. Thus, we opted for a hybrid treatment, implanting a stent graft from the external iliac artery to the proximal common femoral artery and replacing artificial blood vessels from there to the femoral artery bifurcation. The postoperative course was favorable. In this case, we provided the optimal treatment for the patient's condition, despite the impossibility of a radical cure due to the cancer's progression. We believe the infected pseudoaneurysm was adequately controlled, and the hybrid therapy is effective for patients who cannot endure more invasive treatments.