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Settembrini AM, Cannizzo G, Bissacco D, Trimarchi S. A rare case of non-mycotic ruptured popliteal aneurysm. J Vasc Surg 2024; 79:1508-1509. [PMID: 37806600 DOI: 10.1016/j.jvs.2023.10.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2023] [Revised: 09/30/2023] [Accepted: 10/02/2023] [Indexed: 10/10/2023]
Affiliation(s)
- Alberto M Settembrini
- Department of Cardio Thoracic and Vascular Diseases, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.
| | - Giuseppe Cannizzo
- Department of Cardio Thoracic and Vascular Diseases, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Daniele Bissacco
- Department of Cardio Thoracic and Vascular Diseases, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy; Department of Clinical and Community Sciences, Università degli Studi di Milano, Milan, Italy
| | - Santi Trimarchi
- Department of Cardio Thoracic and Vascular Diseases, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy; Department of Clinical and Community Sciences, Università degli Studi di Milano, Milan, Italy
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2
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Shi M, Hewagama S, Bayat I. Ruptured popliteal artery aneurysm caused by Streptococcus gordonii infective endocarditis. ANZ J Surg 2023; 93:736-737. [PMID: 35870120 DOI: 10.1111/ans.17945] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Revised: 03/29/2022] [Accepted: 06/24/2022] [Indexed: 11/29/2022]
Affiliation(s)
- Margaret Shi
- Department of Vascular Surgery, Northern Health, Melbourne, Victoria, Australia
| | - Saliya Hewagama
- Department of Infectious Diseases, Northern Health, Melbourne, Victoria, Australia
| | - Iman Bayat
- Department of Vascular Surgery, Northern Health, Melbourne, Victoria, Australia
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3
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Bunde SG, Osigwe CC, Hager E. A Case Report: Ruptured Popliteal Aneurysm Caused by Haemophilus Influenzae Infection. Ann Vasc Surg 2021; 79:442.e1-442.e4. [PMID: 34655753 DOI: 10.1016/j.avsg.2021.08.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Revised: 07/28/2021] [Accepted: 08/03/2021] [Indexed: 11/27/2022]
Abstract
Mycotic aneurysms arise from infection of an arterial wall secondary to septic emboli from endocarditis. Although rare, most mycotic aneurysms involve the abdominal aorta, with Staphylococcus aureus and Salmonella spp being the most common causative organisms. We report a case of an 81-year-old woman with a ruptured mycotic popliteal aneurysm from Haemophilus influenzae infection.
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Affiliation(s)
- Sophia G Bunde
- University of Pittsburgh School of Medicine, Pittsburgh, PA.
| | | | - Eric Hager
- University of Pittsburgh School of Medicine, Pittsburgh, PA; Department of Vascular Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA
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4
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Kojima S, Nakama T, Obunai K, Watanabe H. Ruptured infected popliteal artery aneurysm treated with endovascular therapy: A case report. JRSM Cardiovasc Dis 2021; 10:20480040211027792. [PMID: 34276972 PMCID: PMC8256240 DOI: 10.1177/20480040211027792] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Revised: 03/14/2021] [Accepted: 06/07/2021] [Indexed: 11/16/2022] Open
Abstract
An 86-year-old woman was admitted for a ruptured popliteal artery aneurysm (rPAA,
26 × 28 mm). Due to the patient’s age and comorbidities, emergency endovascular repair was
performed. After the failed antegrade guidewire crossing, a retrograde approach from the
anterior tibial artery and snaring was performed for lesion crossing, and stentgraft
(5 × 50 mm) was deployed from antegrade fashion. At the 14-month follow-up, computed
tomography angiogram demonstrated stentgraft patency and reduced aneurysmal size. Although
open surgery remains the first-line treatment for infected rPAA, our approach adds to the
evidence and can be applied to emergency cases or high-risk surgical patients.
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Affiliation(s)
- Shunsuke Kojima
- Department of Cardiology, Tokyo Bay Medical Center, Urayasu, Japan
| | - Tatsuya Nakama
- Department of Cardiology, Tokyo Bay Medical Center, Urayasu, Japan
| | - Kotaro Obunai
- Department of Cardiology, Tokyo Bay Medical Center, Urayasu, Japan
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Successful Endovascular Repair of a Ruptured Popliteal Artery Aneurysm: A Case Report and Literature Review. Case Rep Vasc Med 2020; 2020:8745780. [PMID: 32257507 PMCID: PMC7102448 DOI: 10.1155/2020/8745780] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2019] [Accepted: 03/04/2020] [Indexed: 11/17/2022] Open
Abstract
Introduction. It is rare for a popliteal artery aneurysm (PAA) to present with rupture. This case reports a longer-term success in the management of a large ruptured popliteal artery aneurysm with an endovascular approach, with a literature review of management of such cases. Case Report. An 80-year-old man presented to the accident and emergency department with pain and swelling behind the left knee and at the back of the thigh. An ultrasound scan and subsequent CT angiogram revealed a large 9.4 cm ruptured PAA. The patient had significant comorbidities deeming him unfit for a major surgical intervention of drainage of haematoma and exclusion bypass. Therefore, he underwent urgent endovascular treatment of the ruptured PAA with a covered stent graft. A follow-up duplex scan at 1 year showed a patent stent with no evidence of endoleak, and the patient remained asymptomatic. A clinical follow-up at 18- and 24-month postprocedure showed a patent stent graft and complete resolution of haematoma. Conclusion. Whilst open repair with exclusion bypass may still be a treatment of choice, an endovascular approach is both safe and effective in the management of a ruptured PAA in an unfit patient with an acceptable longer-term outcome.
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Nakagawa T, Shibuya T, Oono M, Kudou T, Watanabe K, Uenaka N, Kaneko M, Sawa Y. An Infected Popliteal Aneurysm Simultaneously Treated with Resection and Revascularization. Ann Vasc Dis 2019; 12:541-544. [PMID: 31942216 PMCID: PMC6957901 DOI: 10.3400/avd.cr.19-00076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Infected popliteal aneurysm is a high-risk condition that may present as an emergency requiring an urgent attention with acute rupture and sepsis. The management of acute ischemia in the presence of local and systemic sepsis is challenging, and infection control and perioperative management during surgery are important. Here we report successful case of treating a patient with an infected popliteal aneurysm. The infection seemed to arise from the soft tissue surrounding the aneurysm, following cellulitis. Our report also includes a review of the related literature and suggests that devising methods for infection control is critical in achieving acceptable outcomes in such cases.
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Affiliation(s)
- Takaya Nakagawa
- Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - Takashi Shibuya
- Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - Masato Oono
- Department of Cardiovascular Surgery, Suita Tokushukai Hospital, Suita, Osaka, Japan
| | - Tomoaki Kudou
- Department of Cardiovascular Surgery, Suita Tokushukai Hospital, Suita, Osaka, Japan
| | - Kenichi Watanabe
- Department of Cardiovascular Surgery, Suita Tokushukai Hospital, Suita, Osaka, Japan
| | - Nagasumi Uenaka
- Department of Cardiovascular Surgery, Suita Tokushukai Hospital, Suita, Osaka, Japan
| | - Mitsunori Kaneko
- Department of Cardiovascular Surgery, Suita Tokushukai Hospital, Suita, Osaka, Japan
| | - Yoshiki Sawa
- Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
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Abstract
BackgroundRupture is a recognised complication of ruptured popliteal artery aneurysms that requires emergency intervention. There is little evidence collating the presentation, intervention and outcomes of ruptured popliteal artery aneurysms.ObjectiveThe primary aim of this study was to deduce the sequelae following different management modalities of ruptured popliteal artery aneurysm.MethodsWe performed a systematic review of all available cases reports of ruptured popliteal artery aneurysms in accordance with the Preferred Reporting Items for Systematic reviews and Meta-Analysis Protocol.ResultsWe identified 48 cases taken from 35 case reports and series. Men were more commonly affected ( n = 96%), and mean age was 71 years. Acute limb ischemia was the commonest presentation (32%) whilst incidental deep vein thrombosis was found in 43% of patients. The mean aneurysm size was 8.2 cm (range, 2.7 to 13.3 cm). Management consisted of open surgery (58%), endovascular treatment (25%) and ‘other’ treatment (evacuation of haematoma, ligation of aneurysm, amputation or palliation) (17%). The perioperative mortality rate in the whole cohort was 13%. Perioperative mortality was similar between comparing the open and endovascular surgery groups. Re-intervention rate amongst endovascular patients was 25% over an average follow-up period of 14 months. There was one re-intervention in the re-constructive group (3%) over a follow-up period of 17 months and none in the ‘other’ group.ConclusionPopliteal artery aneurysm rupture is a serious complication associated with significant morbidity and mortality. Open surgical reconstruction and endovascular repair are both feasible for the treatment of ruptured popliteal artery aneurysms; however, open surgery is less likely to require further re-intervention.
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Affiliation(s)
- James Akman
- 1 Department of Vascular and Endovascular Surgery, The Royal Oldham Hospital, Pennine Acute Hospitals NHS Trust, Manchester, UK
| | - Emmanuel Katsogridakis
- 1 Department of Vascular and Endovascular Surgery, The Royal Oldham Hospital, Pennine Acute Hospitals NHS Trust, Manchester, UK.,2 Academic Surgery Unit, University Hospital of South Manchester, Manchester, UK
| | - George A Antoniou
- 1 Department of Vascular and Endovascular Surgery, The Royal Oldham Hospital, Pennine Acute Hospitals NHS Trust, Manchester, UK
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8
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Mikhaylov IP, Lavrenov VN, Isaev GA, Kokov LS, Trofimova EY. [Ruptures of popliteal artery aneurysms]. Khirurgiia (Mosk) 2018:57-62. [PMID: 29697685 DOI: 10.17116/hirurgia2018457-62] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
AIM To improve diagnosis and surgical outcomes in patients with ruptured popliteal artery aneurysm. MATERIAL AND METHODS Eight patients with ruptured popliteal artery aneurysm have undergone surgery for the period from 1999 to 2015 at the Vascular Surgery Department of Sklifosovsky Research Institute for Emergency Care. Incidence of rupture was 2.9% from total number of popliteal artery aneurysm. 7 patients with rupture had signs of lower limb ischemia (acute form grade I in 2 (25%) cases, grade IIA in 1 (12.5%), grade IIB in 1 (12.5%) case, chronic ischemia grade IIB in 2 (25%) patients, grade III in 1 (12.5%) patient). 1 (12,5%) patient had not lower limb ischemia. Preoperatively all patients underwent sonography of lower limb arteries and soft tissues, computed tomography of the same structures was carried out in 3 patients, 5 patients underwent subtraction digital angiography. Presence and dimensions of soft tissues hematoma, arterial perfusion proximally and distally to popliteal artery, aneurysms of contralateral limb and other localizations were assessed. RESULTS Amputations after surgical repair were absent in 6 patients. Five patients were discharged with patent graft, completely compensated blood flow and primary healing of postoperative wound. Severe postoperative complications followed by amputation occurred in 2 patients. One patient died with reperfusion syndrome, hematoma and graft infection, sepsis. CONCLUSION 1) Ruptured popliteal artery aneurysm is extremely rare complication, however it is a formidable event with high risk of amputation and death. 2) Early diagnosis of popliteal artery aneurysm and surgical treatment prior to embolism, thrombosis and rupture are necessary to prevent formidable complications. 3) Timely detection of aneurysms and their complications by general practitioners is extremely low due to rarity and specificity of the disease, presence of various symptoms. It is necessary to popularize knowledge about this disease among general practitioners. 4) Sonography is screening method for differential diagnosis. 5) CT-angiography or subtraction angiography are advisable to assess distal perfusion if patient's state is stable without severe ischemia. 6) Aneurysm repair with popliteal artery replacement should be performed in early period after rupture in order to reduce time of ischemia and to prevent infection of hematoma in view of ischemia and anemia.
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Affiliation(s)
- I P Mikhaylov
- Sklifosovsky Research Institute for Emergency Care, Moscow Healthcare Department, Moscow, Russia
| | - V N Lavrenov
- Sklifosovsky Research Institute for Emergency Care, Moscow Healthcare Department, Moscow, Russia
| | - G A Isaev
- Sklifosovsky Research Institute for Emergency Care, Moscow Healthcare Department, Moscow, Russia
| | - L S Kokov
- Sklifosovsky Research Institute for Emergency Care, Moscow Healthcare Department, Moscow, Russia
| | - E Yu Trofimova
- Sklifosovsky Research Institute for Emergency Care, Moscow Healthcare Department, Moscow, Russia
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9
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Brown SL, Lewis M, Morrow DR. Endovascular Repair of Ruptured Popliteal Artery Aneurysms: A Case Report and Review of the Literature. EJVES Short Rep 2016; 32:24-28. [PMID: 28856312 PMCID: PMC5576006 DOI: 10.1016/j.ejvssr.2016.07.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2016] [Revised: 06/15/2016] [Accepted: 07/03/2016] [Indexed: 10/31/2022] Open
Abstract
OBJECTIVE/BACKGROUND The 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. METHODS A 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. RESULTS The 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. CONCLUSION Safe 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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Affiliation(s)
- S L Brown
- Department of Vascular Surgery, Norfolk and Norwich University Hospital, Colney Lane, Norwich, Norfolk, NR4 7UY, UK
| | - M Lewis
- Department of Interventional Radiology, Norfolk and Norwich University Hospital, Colney Lane, Norwich, Norfolk, NR4 7UY, UK
| | - D R Morrow
- Department of Vascular Surgery, Norfolk and Norwich University Hospital, Colney Lane, Norwich, Norfolk, NR4 7UY, UK
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Artigues I, Grifo I, Jareño S, Barbas M. Rotura de aneurisma poplíteo micótico tras sepsis por neumonía. ANGIOLOGIA 2015. [DOI: 10.1016/j.angio.2014.07.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Novo Martínez G, Ballesteros Pomar M, Fletes Lacayo J, Menéndez Sánchez E, Santos Alcántara E, Zorita Calvo A. Aneurismas poplíteos rotos: revisión a 28 años. ANGIOLOGIA 2015. [DOI: 10.1016/j.angio.2014.11.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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12
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Gornati VC, da Silva ES, De Luccia N. A rare presentation of ruptured infected popliteal artery aneurysm with massive local emphysema. Vasc Med 2015; 20:491-2. [DOI: 10.1177/1358863x15586474] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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13
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Jolly K, Barratt R, Nair A. A rare case of S treptococcus sanguinis mycotic popliteal aneurysm. JMM Case Rep 2014; 1:e001479. [PMID: 28663804 PMCID: PMC5415927 DOI: 10.1099/jmmcr.0.001479] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2014] [Accepted: 10/15/2014] [Indexed: 01/16/2023] Open
Abstract
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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Affiliation(s)
| | | | - Amit Nair
- Russells Hall Hospital, Dudley DY1 2HQ, UK
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14
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Petersen JCM, Ortiz IHL, Mallón DC, Insua JJV, Casas JRG. Surgical Management of an Infected Popliteal Artery Aneurysm. Vasc Specialist Int 2014. [PMID: 26217625 PMCID: PMC4480294 DOI: 10.5758/vsi.2014.30.3.94] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Infective aneurysms are rare due to the antimicrobial advances and the early treatment of systemic infections. They represent a diagnostic and therapeutic challenge. The treatment for these cases is generally characterised by excision and reconstruction using an autologous vein graft. We describe a case of a 66-year-old man who presented an 8 cm infected popliteal aneurysm where urgent surgical approach was performed. The vascular continuity was restored with a basilic vein. Clinical follow-up showed no signs of recurrent infection and patent bypass without any anastomotic pseudoaneurysm after a year.
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Affiliation(s)
| | | | - Delfin Couto Mallón
- Department of Vascular Surgery, Complexo Hospitalario de Pontevedra, Pontevedra, Spain
| | - Juan José Vidal Insua
- Department of Vascular Surgery, Complexo Hospitalario de Pontevedra, Pontevedra, Spain
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15
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Dua A, Kuy S, Desai SS, Kumar N, Heller J, Lee CJ. Diagnosis and management of a ruptured popliteal mycotic pseudoaneurysm. Vascular 2014; 23:419-21. [PMID: 25245048 DOI: 10.1177/1708538114551193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Infected popliteal aneurysms are a rare but high-risk pathology that may present as a surgical emergency with acute rupture and sepsis. Management of acute ischemia in the presence of systemic sepsis is challenging and requires timely diagnosis, rapid intervention, and multidisciplinary communication to ensure an optimum outcome for both life and limb in these patients. We report on a case of a ruptured mycotic popliteal artery aneurysm as a consequence of septic embolization from infective endocarditis managed by reverse saphenous vein bypass. The clinical presentation, diagnostic process, and approach to management along with a literature review on mycotic popliteal aneurysm are presented in this case report.
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Affiliation(s)
- Anahita Dua
- Division of Vascular Surgery, Department of Surgery, Medical College of Wisconsin, Milwaukee, USA
| | - SreyRam Kuy
- Department of Surgery, Louisiana State University, Shreveport and Overton Brooks Veterans Affairs Medical Center, Shreveport, USA
| | - Sapan S Desai
- Department of Vascular Surgery, Southern Illinois University, Springfield, USA
| | | | - Jennifer Heller
- Division of Vascular Surgery, Department of Surgery, Johns Hopkins Medical Center, Maryland, USA
| | - Cheong J Lee
- Division of Vascular Surgery, Department of Surgery, Medical College of Wisconsin, Milwaukee, USA
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16
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Melendez BA, Hollis HW, Rehring TF. Mycotic popliteal aneurysm rupture secondary to Campylobacter fetus. Ann Vasc Surg 2014; 29:122.e9-11. [PMID: 24930978 DOI: 10.1016/j.avsg.2014.05.021] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2014] [Revised: 05/01/2014] [Accepted: 05/18/2014] [Indexed: 10/25/2022]
Abstract
BACKGROUND Mycotic aneurysms of the popliteal artery are uncommon. Popliteal aneurysms rarely rupture. The authors present the second reported case of popliteal artery rupture as a result of Campylobacter fetus infection. This report confirms the arterial destructive potential of C. fetus infection in a peripheral artery. METHODS An 85-year-old male who had previously undergone endovascular abdominal aortic aneurysm repair in 2007 presented with positive blood cultures for C. fetus. No endocarditis was detected. No periprosthetic fluid to suggest aortic endograft infection was present. During hospitalization for sepsis, he developed acute right knee pain and swelling. A 5.2-cm popliteal aneurysm, with contained rupture, was found on ultrasound and confirmed by computed tomography and angiography. Recommendations for treatment and a literature review are provided. RESULTS This patient was successfully managed with total excision of the aneurysm via a posterior approach with reconstruction through a medial approach using autologous saphenous vein bypass. Culture-directed antibiotic therapy (6 weeks of intravenous ertapenem) to eradicate the pathogen completed the therapy. The patient is doing well at 18- month follow-up. CONCLUSIONS Mycotic popliteal aneurysm associated with C. fetus is a rare but potentially fatal condition. Isolating C. fetus should alert the surgeon to the peripheral arterial destructive potential of this pathogen, as manifested by acute rupture in this patient. Traditional resection through a posterior approach and revascularization through noncontaminated tissue with culture-directed therapy are the treatments of choice.
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Affiliation(s)
- Barbara A Melendez
- Department of Graduate Medical Education, Exempla Saint Joseph Hospital, Denver, CO.
| | - Harris W Hollis
- Department of Graduate Medical Education, Exempla Saint Joseph Hospital, Denver, CO
| | - Thomas F Rehring
- Department of Vascular Therapy, Colorado Permanente Medical Group, Denver, CO
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