PERCUTANEOUS BALLOON CATHETER VASCULAR CONTROL FOR INFECTED AXILLARY ARTERY PSEUDOANEURYSM

The treatment of choice for the septic aortic prosthesis remains graft excision and extra-anatomic revascularization usually with axillofemo ral bypass. Several recent retrospective series report secondary graft infection rates in these remedial procedures that range from 5-10%. I n this setting, proximal axillary artery anastomotic disruption with p seudoaneurysm formation poses an especially vexing problem for the sur geon. We report a case of secondary graft infection presenting as unus ually large, perianastomotic pseudoaneurysm formation. Our desire to a void thoracotomy and the potential intrathoracic spread of infection p rompted us to achieve proximal control by endovascular means. Balloon occlusion of the axillary artery proximal and distal to the graft anas tomosis was achieved angiographically by percutaneous puncture of the ipsilateral brachial artery at two separate sites. This facilitated pr ompt removal of the infected graft with minimal intraoperative blood l oss. Our favorable experience with this approach suggests a role for i ts more general application in the management of infected perianastomo tic pseudoaneurysm.