Retroperitoneal trans-inguinal-ligament bypass for device-related infected femoral pseudoaneurysm

An 85-year-old man developed a device-related infected femoral pseudoaneurysm after carotid artery stenting. Because rupture was feared, initial treatment consisted of minimal skin incision drainage and empiric intravenous antibiotics. After improvement in inflammatory markers and general condition, a salvage bypass from the distal external iliac artery to the mid-superficial femoral artery was created with a reversed great saphenous vein graft via a retroperitoneal trans-inguinal-ligament lateral groin route, followed by excision of infected arterial segments, serial debridement, and delayed contralateral rectus abdominis muscle flap coverage. At 16 months, bypass patency, limb perfusion, and infection control were maintained.