A Case of Metachronous Ruptured Mycotic Femoral Artery Aneurysm

Kikuchi Shinsuke, Inaba Masashi, Kokubo Taku, Yoshida Yuri, Uchida Daiki, Sasajima Tadahiro

doi:10.11401/jsvs.21.615

We report the case of an 89-year-old man with a mycotic femoral artery aneurysm. He had a past history of hemiplegia and chronic renal failure secondary to pneumonia which had required hemodialysis. He presented with redness, swelling and an approximately 6-cm pulsatile mass of the right lower abdomen and groin. Computed tomography (CT) showed a ruptured right common femoral artery pseudoaneurysm. Methicillin-resistant staphylococcus aureus (MRSA) was detected by blood culture. An emergency obturator bypass, proximal anastomosis to the right external iliac artery, and a below-the-knee distal anastomosis to the right popliteal artery was performed, and the femoral artery was ligated proximally and distally. Postoperatively, the wound healed with a series of local therapy. However, at 7 months postoperatively, he demonstrated swelling in the mid-thigh, separate from the previous inguinal wound. We diagnosed a ruptured right superficial femoral artery (SFA) pseudoaneurysm by CT. Intraoperatively, a sparse zone of calcification of the SFA ruptured, and hematoma formed among his muscles. Emergency ligation of the proximal and distal femoral artery was therefore performed. Moreover, MRSA was also detected in the hematoma but the patient was discharged without severe complications. We present a case in which mycotic aneurysm ruptured metachronously, and we strongly suspected persistent MRSA infection in the throat and nasal vestibule which contributed to the aneurysms. Obturator bypass is considered one of the best options to treat critical femoral artery infection in a compromised patient.

A Case of Metachronous Ruptured Mycotic Femoral Artery Aneurysm

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