Superficial femoral artery pseudoaneurysm at implantation site of drug eluting stent discovered due to bacteremia: A case report

Abstract

BACKGROUND

Drug-eluting stents (DES) are used to treat lower extremity arterial disease. During DES treatment, aneurysmal degeneration occasionally occurs, especially with fluoropolymer-based DES. However, the incidence of pseudoaneurysms after DES placement is rarely reported in the lower extremity region, although there have been several reports on pseudoaneurysm formation after DES pla-cement in the coronary artery region.

CASE SUMMARY

We report the case of a 64-year-old man who presented with fever and pain in his left hand after dialysis. Bacteremia was diagnosed by blood culture, and after admission, he developed pain on the medial side of the right thigh. A pseudoaneurysm was observed in the right superficial femoral artery (SFA) at the proximal end of a previously placed DES. The bacteremia was thought to have been caused by a pseudoaneurysm of the left superficial brachial artery, and the pseudoaneurysm of the left superficial brachial artery was removed after antibiotic treatment. The pseudoaneurysm of the right SFA rapidly expanded after admission, but the expansion rate was reduced after infection control. Seven months after the first admission, the pseudoaneurysm of the left SFA was re-moved and in situ revascularization performed using a rifampicin-soaked Dacron graft.

CONCLUSION

Although pseudoaneurysm after DES placement in the lower extremity region is rare, it must be considered in patients with bacteremia.

Keywords: Pseudoaneurysm; Drug eluting stent; Superficial femoral artery; Bacteremia; Revascularization; Case report

Core Tip: We report a relatively rare case of pseudoaneurysm formation after the placement of a drug-eluting stent in the superficial femoral artery. This pseudoaneurysm was discovered after the development of bacteremia and removed because of suspicion of an infected aneurysm. This report describes an uncommon presentation of pseudoaneurysm, which suggests that pseudoaneurysm should be considered as a differential diagnosis along with degenerative aneurysm in patients with bacteremia after placement of a drug-eluting stent.