Explantation of infected DETOUR bypass and repair of associated arteriovenous fistula using Esmarch-assisted vascular isolation technique

Percutaneous transmural arterial bypass (PTAB), or DETOUR, is a technique for treatment of femoropopliteal occlusive disease with endovascular, extra-anatomic bypass stent grafting. Although studies show promise, reports on the management of infection and structural failure of the PTAB stent graft system are lacking. We describe the case of an 80-year-old man who developed an enlarging infected femoral artery pseudoaneurysm, arteriovenous fistula, and deep venous thrombosis following PTAB. Removal of the stents was performed using total vascular isolation of the limb with open arterial exposure and clamping, Esmarch exsanguination of the venous system and iliofemoral reconstruction with rifampin-soaked Dacron and vascularized soft tissue coverage.