Endovascular management of ruptured infected popliteal artery aneurysm

Objective/BackgroundThe objectives were to report the management and outcomes of a 96-year-old man who presented with an acutely swollen right leg due to a ruptured popliteal aneurysm, and to review the relevant literature.MethodsA ruptured popliteal artery aneurysm is a rare diagnosis and is one that is often missed at time of presentation. Previous case reports have documented successful outcomes following surgical repair, and a smaller number following endovascular repair. This is a case report of a 96-year-old man who eventually underwent endovascular repair of a ruptured popliteal artery aneurysm after a delay in diagnosis. A literature review was performed to analyse published data in this field.ResultsThe patient underwent an uncomplicated endovascular repair with a GORE® VIABAHN® stent. A 15-week follow-up ultrasound demonstrated biphasic flow in a patent stent-graft with an unchanged aneurysm sac size and no evidence of an endoleak. A review of the literature demonstrated nine cases of ruptured non-mycotic popliteal artery aneurysms treated endovascularly. Seven cases survived the postoperative period, three had no follow-up recorded, and four cases had patent stent-grafts at time of follow-up.ConclusionSafe and effective endovascular repair of a ruptured popliteal artery aneurysm with endograft patency seen at the 15-week follow-up is reported. Review of the literature suggests that open repair remains the first-line management choice; however, endovascular repair is a valuable alternative. There is a further need for longer-term monitoring of endograft patency following endovascular repair.

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“…Both endografts were patent at the 6-month and 2-year follow-up 2, 5. The remaining six cases were surgically managed.…”

Section: Discussionmentioning

confidence: 92%

“…Out of the 58 cases, eight were mycotic of which two were repaired using endovascular techniques 5, 6. Both endografts were patent at the 6-month and 2-year follow-up 2, 5.…”

Section: Discussionmentioning

confidence: 99%

Endovascular Repair of Ruptured Popliteal Artery Aneurysms: A Case Report and Review of the Literature

Brown

Lewis

Morrow

2016

EJVES Short Reports

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“…The literature suggests that even mycotic aneurysm can be now repaired covered stents [5,7,8], coiling [9] and embolization [10] with no apparent risk of inserting foreign material in an infected field. We did not consider an endovascular approach as there was a theoretical risk of infection of a stent.…”

Section: Discussionmentioning

confidence: 99%

“…Several treatment modalities have been described for management of these mycotic aneurysms including open surgical approach [3], open approach with tourniquet application and limb exsanguination [4] and endovascular approach [5].…”

Section: Introductionmentioning

confidence: 99%

Management of a Ruptured Mycotic Superficial Femoral Artery Aneurysm

et al. 2016

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Aneurysms of peripheral arteries of the leg like the iliac, superficial femoral or popliteal arteries are quite rare. They often tend to coexist or develop later in other vessels in patients who have been treated at one site. They usually present with symptoms of compression of adjacent structures usually the veins or nerves or by distal embolization of the vessels causing a trash foot. It is extremely rare for them to present with a rupture. If this rare event does occur, one has to have strong suspicion of a mycotic (infected) aneurysm. We present a rare case of a ruptured superficial artery aneurysm and its successful management.

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“…At least two case reports describe the use of endovascular techniques to manage a ruptured infected popliteal artery aneurysm, both with satisfactory short- to medium-term outcomes. Whilst there is the benefit of endovascular treatment being minimally invasive, this has to be balanced with the risk of implanting synthetic graft material in an infected space (Schimmer & Somjen, 2009;Bani–hani et al , 2012). This technique may become more popular with recently published improved patency rates for non-mycotic popliteal artery aneurysms treated endovascularly (Bani–hani et al , 2012).…”

Section: Discussionmentioning

confidence: 99%

A rare case of Streptococcus sanguinis mycotic popliteal aneurysm

2014

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Introduction:Mycotic popliteal aneurysms are not a common phenomenon. They can initially be easily confused with other more trivial conditions such as a Baker’s cyst. We present a case of a patient presenting with a progressively worsening leg swelling which was initially misdiagnosed. Only until symptoms rapidly progressed was a popliteal aneurysm diagnosed. To our knowledge this is the only identified case of a Streptococcus sanguinis mycotic popliteal aneurysm.Case presentation:An 81-year-old gentleman presented to the surgical assessment unit with a six-week history of a painful, diffuse swelling in the left popliteal fossa. Initially, when symptoms developed a provisional diagnosis of a Baker’s cyst was made. When the symptoms progressed to involve swelling of the entire lower limb, an ultrasound was arranged. Detailed Imaging revealed a popliteal aneurysm with signs of rupture. Urgent repair was performed, with high suspicion of a mycotic aneurysm intra-operatively. Cultures confirmed this, isolating Streptococcus sanguinis. Multiple investigations failed to isolate an acute infective source of this infection. The patient recovered promptly with a long course of intravenous antibiotics, being able to mobilize normally.Conclusion:Mycotic popliteal aneurysms are not very common and can easily be confused with other benign lesions. The key to diagnosis is the presence of a pulsatile mass and further detailed imaging. This case was unique in that Streptococcus sanguinis has not been isolated from such an aneurysm until now. The most likely explanation of this case was that the aneurysm was secondary to transient bacteraemia of this organism through the oral cavity, in the absence of any cardiac involvement.

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Endovascular management of ruptured infected popliteal artery aneurysm

Cited by 22 publications

References 9 publications

Endovascular Repair of Ruptured Popliteal Artery Aneurysms: A Case Report and Review of the Literature

Endovascular Repair of Ruptured Popliteal Artery Aneurysms: A Case Report and Review of the Literature

Management of a Ruptured Mycotic Superficial Femoral Artery Aneurysm

A rare case of Streptococcus sanguinis mycotic popliteal aneurysm

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