Jornal Vascular Brasileiro
https://www.jvascbras.org/article/doi/10.1590/1677-5449.200095
Jornal Vascular Brasileiro
Case Report

Persistent mycotic superficial femoral artery pseudoaneurysm after endovascular treatment: a case report

Pseudoaneurisma micótico persistente da artéria femoral superficial após tratamento endovascular: relato de caso

Ruth Fuente; Francisco J. Medina; Natalia Moradillo; Ignacio Agúndez; Mónica Herrero; Victoria Santaolalla

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Abstract

Abstract: Mycotic pseudoaneurysms of the superficial femoral artery (SFA) are rare and are usually secondary to colonization of an atherosclerotic plaque during an episode of bacteremia. We describe the case of a 68 year-old diabetic male who presented to the Emergency Department with pyrexia and a painful expanding mass in the left thigh. He had a history of diarrhea and had been treated 16 days earlier for an SFA pseudoaneurysm that had been excluded with a covered stent with no adjunctive antibiotic therapy. Angio CT showed an abscess surrounding femoral vessels and stent thrombosis. Under general anesthesia, we performed extensive debridement, removal of the endovascular material, SFA ligation, and empirical antibiotic therapy. Blood and tissue cultures were positive for Escherichia coli. At the 3-months follow up visit, the patient reported he had no claudication. In selected patients, mycotic pseudoaneurysms can be treated by SFA ligation.

Keywords

mycotic pseudoaneurysm, endovascular treatment, stent thrombosis, Escherichia coli, arterial ligation, superficial femoral artery

Resumo

Resumo: Pseudoaneurismas micóticos da artéria femoral superficial (AFS) são raros, e geralmente são secundários à colonização de uma placa aterosclerótica durante bacteremia. Relatamos o caso de um paciente masculino diabético de 68 anos que chegou ao Serviço de Emergência com pirexia e massa expansiva dolorosa na coxa esquerda. Apresentava histórico de diarreia e havia sido tratado 16 dias antes para pseudoaneurisma da AFS, que foi excluído com stent coberto e sem antibioticoterapia adjuvante. A angiotomografia computadorizada demonstrou um abscesso ao redor dos vasos femorais e trombose do stent. Sob anestesia geral, realizamos desbridamento extenso, remoção do material endovascular, ligadura de AFS e antibioticoterapia empírica. Culturas de sangue e tecidos foram positivas para Escherichia coli. Na consulta de seguimento aos 3 meses, o paciente negou claudicação. Em pacientes selecionados, pseudoaneurismas micóticos podem ser tratados com ligadura de AFS.
 

Palavras-chave

pseudoaneurisma micótico, tratamento endovascular, trombose de stent, Escherichia coli, ligadura arterial, artéria femoral superficial

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Submitted date:
09/10/2020

Accepted date:
12/13/2020

614ddbb8a9539519532c4172 jvb Articles
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