背景:药物洗脱支架(DES)用于治疗下肢动脉疾病。在DES治疗期间,偶尔会发生动脉瘤变性,特别是含氟聚合物基DES。然而,在下肢区域很少报道DES放置后假性动脉瘤的发生率,尽管有一些关于冠状动脉区域DESpla水泥后假性动脉瘤形成的报道。
方法:我们报告一例64岁男性透析后出现发热和左手疼痛的病例。血培养诊断菌血症,入院后,他的右大腿内侧出现疼痛。在先前放置的DES的近端右股浅动脉(SFA)中观察到假性动脉瘤。菌血症被认为是由左肱浅动脉假性动脉瘤引起的,抗生素治疗后切除左肱浅动脉假性动脉瘤。右侧SFA假性动脉瘤入院后迅速扩张,但感染控制后扩张率降低。第一次入院七个月后,使用利福平浸泡的Dacron移植物,对左侧SFA的假性动脉瘤进行了再移动,并进行了原位血运重建.
结论:尽管在下肢区域放置DES后假性动脉瘤很少见,菌血症患者必须考虑。
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.
METHODS: 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.
CONCLUSIONS: Although
pseudoaneurysm after DES placement in the lower extremity region is rare, it must be considered in patients with bacteremia.