Fracture of a covered stent–graft due to heterotopic ossification of residual hematoma after endovascular treatment of superficial femoral artery pseudoaneurysm: A case report

RATIONALE: Endovascular treatment (EVT) is considered a preferred procedure of superficial femoral artery (SFA) pseudoaneurysm in recent years. However, heterotopic ossification (HO) after SFA pseudoaneurysm is a rare occurrence, that may cause late stent–graft fracture. PATIENT CONCERNS: A 58-year-old male who underwent EVT for SFA pseudoaneurysm 8 years ago presented with a progressive mass at the right thigh and claudication. Computed tomography angiography (CTA) showed fracture and occlusion of stent–graft, which was compressed by the deep femoral artery (DFA) pseudoaneurysm and a bone-like body. DIAGNOSIS: According to the CTA images, the stent–graft was fractured and occluded, accompanied by DFA pseudoaneurysm. INTERVENTIONS AND OUTCOMES: Debridement and arterial reconstruction were performed. Pathological analysis showed that the bone-like body was derived from HO. CTA at one-year follow-up showed that the prosthetic vessel was patent and previous hematoma disappeared. CONCLUSIONS: This report demonstrates that residual hematoma can induce HO, which may result in late stent fracture, and it should thus be removed timely. Patients with SFA pseudoaneurysm who have undergone EVT should be followed up regularly.