Tratamento híbrido para revascularização de membro inferior em paciente com infecção de prótese vascular: relato de caso
Hybrid treatment for lower limb revascularization in a patient with vascular graft infection: a case report
Eduardo Lichtenfels; Nilon Erling Junior; Newton Roesch Aerts; Andre Silvestri Reitz da Costa
Resumo
Palavras-chave
Abstract
Patients with severe arterial obstructive disease and critical limb ischemia associated with vascular graft infection have elevated morbidity and mortality rates and are at high risk of limb loss. We present the case of a 76-year-old male patient with left lower limb critical ischemia and a femoropopliteal vascular graft infection. We used a hybrid treatment approach with an open surgical approach to the inguinal and popliteal regions and used the vascular prosthesis as endovascular access for direct recanalization of the superficial femoral artery, because the long occlusion and extensive calcification had frustrated initial attempts at endovascular treatment. After endovascular recanalization, the infected graft was removed. Used in conjunction with open surgery, advances in endovascular techniques and materials offer new solutions for patients when usual procedures fail.
Keywords
References
1 Dosluoglu HH, Lall P, Cherr GS, Harris LM, Dryjski ML. Role of simple and complex hybrid revascularization procedures for symptomatic lower extremity occlusive disease. J Vasc Surg. 2010;51(6):1425-35.e1.
2 Dougherty MJ, Young LP, Calligaro KD. One hundred twenty five concomitante endovascular and open procedures for lower extremity arterial disease. J Vasc Surg. 2003;37(2):316-22.
3 Reed AB. Hybrid procedures and distal origin grafts. Semin Vasc Surg. 2009;22(4):240-4.
4 Patel SD, Donati T, Zayed H. Hybrid revascularization of complex multilevel disease: a paradigm shift in critical limb ischemia treatment. J Cardiovasc Surg. 2014;55(5):613-23. PMid:24941240.
5 Schrijver AM, Moll FL, De Vries JPP. Hybrid procedures for peripheral obstructive disease. J Cardiovasc Surg. 2010;51(6):833-43. PMid:21124279.
6 Soares TR, Manuel V, Amorim P, et al. Hybrid surgery in lower limb revascularization: a real-world experience from a single center. Ann Vasc Surg. 2019;60:355-63.
7 Takayama T, Matsumura JS. Complete lower extremity revascularization via a hybrid procedure for patients with critical limb ischemia. Vasc Endovascular Surg. 2018;52(4):255-61.
8 Giannopoulos S, Palena LM, Armstrong EJ. Technical success and complication rates of retrograde arterial access for endovascular therapy for critical limb ischaemia: a systematic review and meta-analysis. Eur J Vasc Endovasc Surg. 2021;61(2):270-9.
9 Perry M, Callas PW, Alef MJ, Bertges DJ. Outcomes of peripheral vascular interventions via retrograde pedal access for chronic limb-threatening ischemia in a multicenter registry. J Endovasc Ther. 2020;27(2):205-10.
10 Schmidt A, Bausback Y, Piorkowski M, et al. Retrograde tibioperoneal access for complex infrainguinal occlusions: short- and long-term outcomes of 554 endovascular interventions. JACC Cardiovasc Interv. 2019;12(17):1714-26.
11 Edwards WH Jr, Martin RS III, Jenkins JM, Edwards WH Sr, Mulherin JL Jr. Primary graft infections. J Vasc Surg. 1987;6(3):235-9.
12 França LHG, Stahlke HJ, Garschagen MT, Parchen CFR. Fatores de risco associados à infecção, amputação e mortalidade em pacientes submetidos a pontes arteriais infra-inguinais. Estudo retrospectivo de 27 casos. J Vasc Bras. 2004;3:214-22.
13 Lichtenfels E, D’Azevedo PA, Frankini AD, Erling N Jr, Aerts NR. Morbidity and mortality associated with arterial surgery site infections by resistant microorganisms. J Vasc Bras. 2014;3(3):175-81.
14 Liekweg WG Jr, Greenfield LJ. Vascular prosthetic infections: collected experience and results of treatment. Surgery. 1977;81(3):335-42. PMid:841471.
15 Moreira RCR. Infecção local pós-operatória em cirurgia arterial. Cir Vasc Angiol. 1995;11:46-54.
16 Frankini AD, Cardozo MA, Lichtenfels E. Infecção em prótese vascular. In: Brito CJ, editor. Cirurgia vascular. Rio de Janeiro: Revinter; 2008. p. 866-83.
17 Mertens RA, O’Hara PJ, Hertzer NR, Krajewski LP, Beven EG. Surgical management of infrainguinal arterial prosthetic graft infections: review of a thirty-five-year experience. J Vasc Surg. 1995;21(5):782-90, discussion 790-1.
18 Moreira RCR. Infecção em Próteses Vasculares. In: Maffei FHA, editor. Doenças vasculares periféricas. 2. ed. Rio de Janeiro: Guanabara-Koogan; 2002. p. 931-42.
19 Cardozo MA, Frankini AD, Bonamigo TP. Use of superficial femoral vein in the treatment of infected aortoiliofemoral prothetic grafts. Cardiovasc Surg. 2002;10(4):304-10.
20 Ehsan O, Gibbons CP. A 10-year experience of using femoro-popliteal vein for re-vascularisation in graft and arterial infections. Eur J Vasc Endovasc Surg. 2009;38(2):172-9.
21 Jones DW, Meltzer AJ, Schneider DB. Hybrid Approach to limb salvage in the setting of an infected femorol-femoral by-pass graft. Ann Vasc Surg. 2014;28(6):1565.e9-13.
22 Erzurum VZ, Clair D. Endovascular native vessel recanalization to maintain limb perfusion after infected prosthetic vascular graft excision. J Vasc Surg. 2005;41(2):332-6.
Submitted date:
10/13/2021
Accepted date:
02/21/2022
Facebook
Google+
Twitter
LinkedIn
Mendeley
StumbleUpon
CiteULike
Reddit
Email