Self-Expanding Covered Stent Deployment: A Quick Rescue for Venous Bypass Graft Pseudoaneurysm

Purpose: Venous bypass graft (VBG) for peripheral arterial disease (PAD) remains the most used alternative procedure after an endovascular therapy failure. Indeed, femoropopliteal (FP) bypass using vein grafts have shown to have better patency rate. Anastomotic pseudoaneurysms (APAs) are considered a common complication after VBG procedures. They require a quick and an appropriate management because if left untreated, they lead to serious consequences represented essentially by rupture.

Materials and Methods: Herein, we report a case of a 90-year-old female patient without significant cardiovascular risk factors. Otherwise, she had a history of pulmonary embolism under oral anticoagulation and was recently diagnosed with essential thrombocythemia. An open FP repair using an in situ saphenous vein bypass graft was performed as a treatment of critical limb ischemia secondary to FP stents’ thrombosis. On the seventh postoperative day and concomitant with a hypertensive peak, acute pain and edema of the calf was reported, requiring an urgent exploration. A suture line dehiscence of the distal anastomosis was noted and reconfectioned using a prosthetic patch. The ultrasound of control visualized, this time, a nonanastomotic pseudoaneurysm at the proximal site of VBG clamping.

Results: Thus, and on account of the vein wall fragility being noticed during surgery, an abstention of surgical management and an appeal for endovascular option to rescue the limb were decided. Satisfactory clinical and radiologic results were noted as soon as the covered stent was deployed.

Conclusions: An endoprosthesis may be the last chance for the limb safety and be the only reasonable treatment picked by daring physicians. However, forward studies are mandatory to confirm or deny the utility in the long term of covered stents as a treatment of VBG pseudoaneurysms.