Jornal Vascular Brasileiro
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: 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.


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


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.


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


1 Reddy DJ, Lee RE, Oh HK. Suprarenal mycotic aortic aneurysms: surgical management and follow-up. J Vasc Surg. 1986;3(6):917-20. PMid:3754907.

2 Patra P, Ricco J-B, Costargent A, Goueffic Y, Pillet J-C, Chaillou P. Infected aneurysms of neck and limb arteries: a retrospective multicenter study. Ann Vasc Surg. 2001;15(2):197-205. PMid:11265084.

3 Jewkes AJ, Black J. Infection of an abdominal aortic aneurysm from an appendix abscess. J Cardiovasc Surg. 1989;30(5):870-2. PMid:2808512.

4 Osler W. The Gulstonian lectures on malignant endocarditis. BMJ. 1885;1(1262):467-70. PMid:20751186.

5 Wilson SE, Van Wagenern P, Passaro E Jr. Arterial infection. Curr Probl Surg. 1978;15(9):1-89. PMid:581864.

6 Tilson MD. Pathogenesis of mycotic aneurysms. Cardiovasc Surg. 1999;7(1):1-2. PMid:10073751.

7 Buckmaster MJ, Curci JA, Murray PR, et al. Source of elastin-degrading enzymes in mycotic aortic aneurysms: bacteria or host inflammatory response? Cardiovasc Surg. 1999;7(1):16-26. PMid:10073755.

8 Oderich GS, Panneton JM, Bower TC, et al. Infected aortic aneurysms: aggressive presentation, complicated early outcome, but durable results. J Vasc Surg. 2001;34(5):900-8. PMid:11700493.

9 Müller BT, Wegener OR, Grabitz K, Pillny M, Thomas L, Sandmann W. Mycotic aneurysms of the thoracic and abdominal aorta and iliac arteries: Experience with anatomic and extra-anatomic repair in 33 cases. J Vasc Surg. 2001;33(1):106-13. PMid:11137930.

10 Higgins GA, Sandiford JA, Blair WC. Remote Salmonella infections. World J Surg. 1982;6(2):236-40. PMid:7090411.

11 Soliva Martínez D, Belda González I, Relanzón Molinero S. Mycotic pseudoaneurysm in the external carotid artery from Escherichia coli. Acta Otorrinolaringol Esp. 2015;66(5):305-6. PMid:24846564.

12 McCann JF, Fareed A, Reddy S, Cheesbrough J, Woodford N, Lau S. Multi-resistant Escherichia coli and mycotic aneurysm: two case reports. J Med Case Reports. 2009;3(1):6453. PMid:19830106.

13 Yano M, Hayase T, Furukawa K, Nakamura K. Mycotic pseudoaneurysm of the ascending aorta caused by Escherichia coli. Interact Cardiovasc Thorac Surg. 2013;16(1):81-3. PMid:23065748.

14 Furuta T, Tsubokawa T, Takabatake S, Ohtake H, Watanabe G, Yamagishi M. Pseudoaneurysmal formation in abdominal aorta associated vith Escherichia coli infection. Intern Med. 2011;50(9):1025-8. PMid:21532226.

15 Perez Burkhardt JL. Aneurismas micóticos; particularidades diagnósticas y de tratamiento. Angiologia. 2015;68(1):46-54.

16 Kim YW. Infected aneurysm: current management. Ann Vasc Dis. 2010;3(1):7-15. PMid:23555382.

17 Mohan N, Kerr G. Aortitis. Curr Treat Options Cardiovasc Med. 2002;4(3):247-54. PMid:12003723.

18 Klonaris C, Katsargyris A, Vasileiou I, Markatis F, Liapis CD, Bastounis E. Hybrid repair of ruptured infected anastomotic femoral pseudoaneurysms: emergent stent-graft implantation and secondary surgical debridement. J Vasc Surg. 2009;49(4):938-45. PMid:19147320.

19 Xu J, Zheng Z, Yang Y, et al. Clinical evaluation of covered stents in the treatment of superficial femoral artery pseudoaneurysm in drug abusers. Mol Med Rep. 2018;17(3):4460-6. PMid:29344667.

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