Acute management of a ruptured mycotic iliac artery pseudoaneurysm in a young transplant patient.

Abstract

Objectives: Ruptured mycotic pseudoaneurysms are rare, yet devastating complications that can prove challenging to manage. In immunocompromised populations, highly virulent organisms such as Gemella morbillorum can be especially difficult to combat. Here, we outline our approach to temporizing maneuvers in an emergent setting and definitive revascularization in a 27-year-old with a ruptured mycotic iliac artery pseudoaneurysm from necrosis of her kidney and pancreas allografts.

Methods: The initial staged repair involved covered stenting of the right iliac artery for hemorrhagic control of a ruptured pancreatic allograft arterial anastomosis, explant of ipsilaterally placed renal and pancreas allografts from the right pelvis, and iliac artery reconstruction using left femoral vein. Subsequent abscess formation leading to anastomotic blowout required repeat covered stenting followed by a femoral-femoral arterial bypass with right femoral vein.

Results: The patient was discharged home with no further vascular events and preserved lower extremity perfusion. They returned to the clinic 1 month following discharge in stable condition with no wound healing or ischemic complications.

Conclusions: The choice of femoral vein as conduit for in-line arterial repair can provide both better long-term patency and resistance to infection than prosthetic bypass material.