Mycotic aneurysm of the tibioperoneal trunk: a first manifestation of an infected endocarditis

Abstract

SUMMARYInfrapopliteal mycotic aneurysm resulting from endocarditis is rare, with only a few reported cases. We describe the case of a 28-year-old male patient who was suffering with pain and edema in the right leg. The ultrasound revealed an aneurysm of the right tibioperoneal trunk and a deep vein thrombosis (DVT). The patient was admitted and developed acute congestive heart failure, being diagnosed with possible endocarditis. A pseudo-aneurysm was revealed by arteriography. Aggressive antibiotic treatment was initiated, and open surgery confirmed a mycotic pseudo-aneurysm of the tibioperoneal trunk. To our knowledge, this is the 8 th case reported of an infected aneurysm in this particular location.

Celiac Trunk Mycotic Aneurysm: Diagnosis and Treatment of a Post-infective Endocarditis Complication

“…Lower extremity and, more specifically, the bifurcation of the common femoral artery, is the most common peripheral involved district, followed by cerebral and visceral arteries; among visceral arteries the most frequently involved is the superior mesenteric artery. 1,3 One of the earliest imaging finding is the fat stranding which corresponds to the increased attenuation/hazy appearance of the abdominal fat surrounding the interested blood vessel. 4 The pseudoaneurysm usually appears as a focal, saccular, contrast-enhancing outpouching of the arterial wall; other radiological features include periarterial wall edema, irregular arterial wall, while gas formation is uncommon.…”

Spontaneous compartment syndrome and endovascular repair of tibioperoneal trunk pseudoaneurysm in Ehlers-Danlos syndrome

“…Aneurysms or pseudoaneurysms of the TPT are extremely rare, with most associated with trauma, bacteremia, or endocarditis. 9 , 10 For inherited conditions associated with TPT disease, Bechet syndrome has been more prevalent. 11 , 12 Surgical management of TPT disease poses a challenge, especially if the bifurcation is involved.…”

Correção endovascular de pseudoaneurisma de tronco tibiofibular secundário a endocardite – relato de caso

“…They can also be caused by fungal infections, but this is very rare, occurring in 1 to 2% of cases. 3,7 The physiopathogenesis of mycotic pseudoaneurysms is related to septic microembolizations involving the vasa vasorum, leading to ischemia, focal necrosis and weakness of the artery wall, and resulting in rupture and formation of the pseudoaneurysm. In the majority of reports in the literature, these embolizations generate pseudoaneurysms in axial vessels such as the aorta, mesenteric arteries, cerebral vessels, and the femoral arteries, rarely involving infrapopliteal territories, to the extent that just 10 cases are described in literature published up to 2012.…”

“…6 Since then, other cases of pseudoaneurysms in this topography have been reported in the literature and management with traditional surgical techniques remained the first choice. [2][3][4][5][6][7] Endovascular techniques were first used to repair peripheral pseudoaneurysms in 1994. Geremia et al placed endovascular stents in pseudoaneurysms that had been induced in the carotid arteries of dogs, observing thrombosis of the pseudoaneurysm sac and patency of the vessel involved.…”

“…2 Few cases involving infragenicular arteries have been described. [2][3][4][5][6][7] This article describes the case of a pseudoaneurysm of the tibioperoneal trunk with late presentation after treatment for bacterial endocarditis. In this case, after ruling out any type of active infectious process, we decided to manage this patient with a covered stent implantation.…”