1Melek Ben Mrad, 1Fatma Touhami, 1Mleyhi Sobhy, 1Rim Miri, 2Mzoughi Khadija, 2Imtinen Ben Mrad, 2Ihsen Zairi, 1Raouf Denguir
1Cardiovascular Surgery Department, The Rabta Hospital , Tunis, Tunis, Tunisia; 2Cardiology Department, Habib Thameur Hospital, Tunis, Tunis, Tunisia
Infrainguinal pseudoaneurysm associated with Behçet disease are rare. Surgical treatment is problematic with high risk of recurrence of anastomotic false aneurysm
We report the case of an endovascular repair of a superficial femoral artery pseudoaneurysm in a young Tunisian patient with Behçet disease.
A 29-year-old Tunisian male with a known history of Vasculo-Behcet’s disease (v-BD) under daily immunosuppressive therapy, presented with a huge pseudoaneurysm of the left superficial femoral artery. The patient denied any history of trauma, drug abuse, or infective endocarditis.
He underwent endovascular exclusion of the pseudoaneurysm using a covered stent graft. Surgical cut-down followed by direct puncture of the proximal superficial femoral artery was preferred to percutaneous approach in order to reduce the risk of post-operative pseudoaneurysm formation. The procedure and post-operative recovery were successful. Three months DUS confirmed the pseudoaneurysm exclusion, the patency of the endograft and the absence of endoleaks or aneurysm degeneration both at the level of surgical access and endograft landing zone.
In conclusion, this case suggests that endovascular stent-graft repair of BD pseudoaneurysms is a safe alternative to open surgical treatment. The irritation caused by a covered stent graft to the vasculitis arterial wall is an important risk factor for the recurrence of anastomotic pseudoaneurysms in patients with BD after endovascular treatment. Consequently, fully covered stent grafts with matched sizes and sufficient length to keep the fixing barb far from the inflammatory arterial wall of the aneurysm is recommended for endovascular repair of BD aneurysms.