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MRSA-infected external iliac artery pseudoaneurysm treated with endovascular stenting
M G Clarke1, H G Thomas, J F Chester
1Department of Surgery, Taunton & Somerset Hospital, Musgrove Park, Taunton, TA1 5DA, UK.
Abstract:
A 48-year-old woman with severe juvenile-onset rheumatoid arthritis presented with a bleeding cutaneous sinus distal to her right total hip replacement scar. Methicillin resistant Staphylococcus aureus (MRSA) was isolated on culture. She had previously undergone bilateral total hip and knee replacements at aged 23 and six years later had the right knee prosthesis removed for infection, with subsequent osteomyelitis of the femoral shaft and right total hip prosthesis disruption. Peripheral arteriography was performed in view of persistent bleeding from the sinus, which revealed a 6 cm false aneurysm filling from and compressing the right external iliac artery (EIA). A PTFE-covered, balloon expandable JOSTENT was deployed in the right EIA, successfully excluding the false aneurysm and preventing further bleeding from the sinus. No graft infection was reported at 12 months. This case illustrates the potential use of endovascular stent-grafting in the treatment of an infected pseudoaneurysm.
Insights
This case study shows endovascular stent-grafting successfully treated a bleeding pseudoaneurysm in the external iliac artery. This minimally invasive approach offers a viable option for complex infected vascular injuries.
Area of Science:
- Vascular Surgery
- Infectious Disease
- Rheumatology
Background:
- A 48-year-old woman with severe juvenile-onset rheumatoid arthritis and multiple joint replacements presented with a bleeding sinus.
- The patient had a history of multiple orthopedic surgeries, including bilateral hip and knee replacements, complicated by infection and osteomyelitis.
Observation:
- A cutaneous sinus near a right total hip replacement scar exhibited persistent bleeding.
- Cultures identified Methicillin-resistant Staphylococcus aureus (MRSA).
- Peripheral arteriography revealed a 6 cm false aneurysm compressing the right external iliac artery (EIA).
Findings:
- A PTFE-covered, balloon-expandable JOSTENT was successfully deployed in the right EIA.
- The stent-graft excluded the false aneurysm, effectively controlling the bleeding.
- No graft infection was observed at the 12-month follow-up.
Implications:
- Endovascular stent-grafting is a potential treatment for infected pseudoaneurysms, particularly in patients with complex medical histories.
- This minimally invasive technique can be an effective alternative to open surgical repair for managing infected arterial pseudoaneurysms.
- The successful management highlights the importance of multidisciplinary approaches in treating complex vascular complications in patients with chronic inflammatory diseases.
