Mycotic Common Iliac Artery Aneurysm Complicating Methicillin-Resistant Staphylococcus aureus Bacteremia: An Unusual Cause of Ureteric Obstruction

Effect of Endovascular Treatment on Urinary Obstruction Caused by Iliac Artery Aneurysm: A Case Series and Review of the Literature

BACKGROUND

Endovascular aneurysm repair is superior to open surgical repair (OSR) in multiple aspects and is the mainstay for noninflammatory iliac artery aneurysm (IAA) treatment. However, for noninflammatory IAAs with neighboring structures compressed, the experience of endovascular treatment is limited. This case series study aimed to describe the experience of endovascular aneurysm repair of noninflammatory IAAs with urinary obstruction and to review the limited reports in the literature.

METHODS

From December 2012 to July 2020, we reported 7 cases of noninflammatory IAAs combined with urinary obstruction that was treated successfully with endovascular treatment. The literature on noninflammatory IAAs combined with urinary obstruction was reviewed using the online databases PubMed, Embase, and the Cochrane Library.

RESULTS

Thirty nine articles were found in the literature. OSR accounted for 80% of the treatment options in previous publications, while only 20% of patients accepted endovascular treatment. Hydronephrosis remission was observed in all patients treated by OSR, while the endovascular treatment group lacked long-term follow-up. In our retrospective study containing 7 cases, no complications, reintervention, or mortality was observed, all stents were patent, and all symptoms were relieved after the operation. Diameter reduction of the aneurysms was observed in 6/7 cases and the average aneurysm reduction was -24.1 ± 15.8 mm (P = 0.0097). Urinary obstruction faded in 5/7 cases where aneurysm shrinking was found simultaneously.

CONCLUSIONS

This case series and literature review on noninflammatory IAAs combined with urinary obstruction suggests that the diameter of the responsible aneurysm may be reduced after endovascular treatment, which may also alleviate symptoms of urinary obstruction caused by noninflammatory IAAs.

Isolated internal iliac artery infected pseudoaneurysm occlusion using endovascular coil embolisation

A 34-year-old man presented with painful swelling in the right gluteal region. The MRI showed right sacroiliitis and adjacent intramuscular abscess. The abscess was drained by a pigtail insertion followed by incision and drainage. The patient developed persistent bleeding from the drainage site. CT angiogram revealed a large pear-shaped pseudoaneurysm arising from the anterior branch of the right internal iliac artery. The patient had Abrus precatorius poisoning previously resulting in methicillin-resistant Staphylococcus aureus septicaemia, which incited above events. Digital subtraction angiography with coil embolisation of the right internal iliac artery was done under the cover of culture-specific antibiotics along with thorough wound debridement following which the patient's condition improved. Isolated infected pseudoaneurysms of internal iliac arteries, although rare, should be considered in cases of complicated sacroiliitis. Under antibiotic cover, endovascular coil embolisation can be considered as a treatment strategy to treat complicated infected pseudoaneurysms located in difficult anatomical locations.

Deep Leg Vein Reconstruction for an Isolated Mycotic Common Iliac Artery Aneurysm in an HIV-Positive Patient

Isolated mycotic common iliac artery aneurysms are rare, and as such, there is no consensus opinion on management. Traditional surgical options include resection with extra-anatomic bypass, placement of allograft or antibiotic treated synthetic graft, or autogenous vein reconstruction. We report the case of a 46-year-old, human immunodeficiency virus-positive male who presented with a recurrent pneumonia and new onset of right lower quadrant abdominal pain associated with right lower extremity swelling. computed tomographic scan revealed an isolated 9.5 cm right common iliac artery aneurysm with no evidence of rupture. Preoperative blood cultures grew out Streptococcus pneumoniae. Operative repair included aneurysm resection and reconstruction using an autogenous femoropopliteal vein interposition graft from the ipsilateral thigh. The patient had an uneventful recovery with resolution of his lower extremity swelling and a normal duplex exam at follow-up. Large mycotic common iliac artery aneurysms can be successfully treated with aneurysm resection and reconstruction using an autogenous femoropopliteal vein conduit. This technique obviates the need for extra-anatomic bypass or other forms of reconstruction using prosthetic material.

Mycotic Abdominal Aortic Aneurysm Secondary to Septic Embolism of a Thoracic Aorta Graft Infection

Mycotic aneurysms account for 1% of abdominal aortic aneurysms. There are very few cases published that describe the formation of mycotic aneurysms after septic embolism due to graft infection. We present the first case to our knowledge to be described in the literature of a mycotic aneurysm caused by septic embolism derived from a thoracic aorta graft infection, treated with conventional surgery leading to a successful outcome and evolution.