Spiral Vein Graft Reconstruction for an Infected Common Femoral Artery Pseudoaneurysm after Vascular Closure Device and Stent-Graft Failure: A Case Report.

Vascular closure devices (VCDs) allow rapid hemostasis after endovascular procedures but may rarely cause pseudoaneurysms or infections. Infected pseudoaneurysms of the common femoral artery (CFA) following VCD use are uncommon, and stent-graft exclusion is discouraged in infected fields and high-motion sites such as the groin. We report a 68-year-old male with end-stage renal disease on hemodialysis who developed an infected CFA pseudoaneurysm after VCD and subsequent stent-graft placement. The lesion was complicated by vancomycin-intermediate Staphylococcus aureus bacteremia and arterial wall destruction. Surgical debridement and excision of the infected stent-graft were followed by autologous spiral vein graft reconstruction using the contralateral great saphenous vein, extending from the external iliac artery to the proximal superficial femoral artery. Postoperative cultures revealed methicillin-resistant Staphylococcus aureus infection. The patient recovered uneventfully with patent reconstruction and no recurrence. This case highlights the risk of VCD-related infections and supports spiral vein grafting as a durable option.