Unusual source of fever: the curious case of an infected arterial stent graft presenting as a ruptured popliteal artery aneurysm

2021 ◽  
Vol 14 (2) ◽  
pp. e239272
Author(s):  
Emily Kate Edwina Schmidt ◽  
Sherab Bhutia
Keyword(s):  
Stent Graft ◽  
Popliteal Artery ◽  
Graft Infection ◽  
Artery Aneurysm ◽  
Previous Treatment ◽  
Large Collection ◽  
Popliteal Artery Aneurysm ◽  
Ct Angiogram ◽  
Initial Intervention ◽  
History Of

A 71-year-old man presented to the emergency department with a 1-week history of lethargy, general malaise and intermittent high fever. He had presented 18 months ago, and again 12 months earlier with similar symptoms. On this third presentation, the fever was accompanied by right thigh swelling and pain. The patient was referred to the vascular surgeons with concern regarding an infected vascular stent graft from previous treatment of popliteal artery aneurysms (PAA) 8 years earlier. CT angiogram demonstrated a collapsed right PAA sac with a large collection, consistent with ruptured PAA, and a single gas bubble around the indwelling stent graft. The patient recovered well after a course of antibiotics and surgical explantation of the graft. Infection is a potential complication of any implanted arterial advice, and needs to be considered even years after initial intervention and with no localising symptoms.

scholarly journals Successful Endovascular Repair of a Ruptured Popliteal Artery Aneurysm: A Case Report and Literature Review

2020 ◽  
Vol 2020 ◽  
pp. 1-5
Author(s):  
Duncan Muir ◽  
Sachin R. Kulkarni
Keyword(s):  
Case Report ◽  
Literature Review ◽  
Stent Graft ◽  
Popliteal Artery ◽  
Case Reports ◽  
Artery Aneurysm ◽  
Popliteal Artery Aneurysm ◽  
Ct Angiogram ◽  
Endovascular Approach

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.

scholarly journals Thrombosis of popliteal artery aneurysm with cutaneous microembolism of toes

2019 ◽  
Vol 6 (11) ◽  
pp. 4167
Author(s):  
Harilal Nambiar ◽  
Robin George Manappallil ◽  
Pramod Valayanad ◽  
Anoop Madayambath
Keyword(s):  
Popliteal Artery ◽  
Lower Limb ◽  
Artery Aneurysm ◽  
Acute Onset ◽  
Limb Pain ◽  
Popliteal Artery Aneurysm ◽  
Popliteal Entrapment ◽  
Lower Limb Pain ◽  
History Of ◽  
Aneurysm Repair

Popliteal artery aneurysms (PAAs) are rare, and usually affect men over 60 years of age with established cardiovascular disease due to atherosclerosis. They can also be congenital or can occur due to trauma, mycotic aneurysm, popliteal entrapment or inflammatory arteritis. This is a case of a 95 year old male, with history of recent subdural hematoma, who presented with acute onset right lower limb pain and edema. He was found to have right PAA with thrombosis which was throwing cutaneous microemboli to the toes. He underwent open aneurysm repair with Dacron graft and thrombectomy and improved.

scholarly journals Patient with Marfan Syndrome and a Novel Variant in FBN1 Presenting with Bilateral Popliteal Artery Aneurysm

2018 ◽  
Vol 2018 ◽  
pp. 1-4
Author(s):  
Ahmed Mohammad ◽  
Haytham Helmi ◽  
Paldeep S. Atwal
Keyword(s):  
Connective Tissue ◽  
Marfan Syndrome ◽  
Popliteal Artery ◽  
Artery Aneurysm ◽  
Connective Tissue Disorder ◽  
Acute Onset ◽  
The Body ◽  
Leg Pain ◽  
Popliteal Artery Aneurysm ◽  
Ct Angiogram

We present a 43-year-old man with aortic root dilation, mitral valve prolapse, and marfanoid appearance, who presented with acute onset left leg pain. He underwent a Doppler ultrasound that revealed left popliteal artery aneurysm with thrombus. CT angiogram showed bilateral popliteal artery aneurysms. After repairing of his left popliteal artery aneurysm, he was sent for genetic evaluation. He was diagnosed with Marfan syndrome (MFS) based on the revised Ghent criteria and then underwent FBN1 sequencing and deletion/duplication analysis, which detected a novel pathogenic variant in gene FBN1, denoted by c.5872 T>A (p.Cys1958Ser). MFS is a connective tissue disorder with an autosomal dominant inheritance due to pathogenic variants in FBN1 that encodes Fibrillin-1, a major element of the extracellular matrix, and connective tissue throughout the body. MFS involves multiple systems, most commonly the cardiovascular, musculoskeletal, and visual systems. In our case we present a rare finding of bilateral popliteal artery aneurysms in a male patient with MFS.

scholarly journals A Case ofScopulariopsis brevicaulisEndocarditis with Mycotic Aneurysm in an Immunocompetent Host

2015 ◽  
Vol 2015 ◽  
pp. 1-4 ◽  
Author(s):  
Kelly Cawcutt ◽  
Larry M. Baddour ◽  
Mary Burgess
Keyword(s):  
Mitral Valve ◽  
Popliteal Artery ◽  
Artery Bypass ◽  
Artery Aneurysm ◽  
Peroneal Artery ◽  
Popliteal Artery Aneurysm ◽  
Fungal Endocarditis ◽  
History Of ◽  
Scopulariopsis Brevicaulis ◽  
Prosthetic Ring

Scopulariopsisis a genus of mold that is usually associated with onychomycosis and rarely causes complicated infection in immunocompetent persons. We describe a case of an immunocompetent 65-year-old male with a history of mitral valve repair with prosthetic ring placement who developed acute left posterior knee pain. Imaging showed a left popliteal artery aneurysm and thrombus, and further evaluation with transesophageal echocardiogram demonstrated two large, mobile mitral valve vegetations. He underwent debridement and replacement of the mitral valve, followed by debridement of the left popliteal artery with peroneal artery bypass. The intraoperative cultures grewScopulariopsis brevicaulis. Due to the resistant nature of the organism, he was initially treated with combination antifungals including liposomal amphotericin B, caspofungin, and voriconazole and was continued on chronic suppression with posaconazole with no evidence of recurrence.Scopulariopsisis a rare cause of fungal endocarditis. Treatment ofScopulariopsisendocarditis is challenging and is not well understood due to its rarity.

Adherence to instruction for use after endovascular repair of popliteal artery aneurysm

Vascular ◽  
2021 ◽  
pp. 170853812110073
Author(s):  
Axel Wrede ◽  
Leena Lehti ◽  
Jonas Peter Eiberg ◽  
Stefan Acosta
Keyword(s):  
Stent Graft ◽  
Endovascular Repair ◽  
Popliteal Artery ◽  
Artery Aneurysm ◽  
Primary Patency ◽  
Size Difference ◽  
Stent Grafts ◽  
Popliteal Artery Aneurysm ◽  
One Year

Objectives Endovascular repair (ER) of popliteal artery aneurysm (PAA) is an alternative to open repair. However, there is no standardized protocol for when to opt for ER and the decision is therefore at the discretion of the clinician. This study aims to evaluate the adherence to the Instruction For Use (IFU) in patients undergoing ER for PAA and factors associated with stent graft patency at one year. Methods The adherence to IFU provided by the manufacturer in 55 patients treated with Gore Viabahn® Endoprosthesis with Heparin Bioactive Surface for PAA between 2009 and 2019 were retrospectively analyzed. Duplex follow-up was performed at 30 days and one year. Results The two groups of patients treated within ( n = 10) and not within ( n = 45) IFU did not differ in patient demographics, diagnostic assessment, treatment or outcome. Forty-five patients (81.8%) received stent graft placement with at least one deviation according to IFU. Distal oversizing >20% was the most frequent deviation against IFU ( n = 22, 40.0%). Primary patency at one year was 72%. Diameter size difference >1 mm between overlapping stent grafts (6/14 [43%], p = 0.013) and renal insufficiency (5/12 [42%], p = 0.0086) were associated with lower primary patency at one year. Age-adjusted analysis of tortuosity index (HR 1.78/SD, 95% CI 1.17–2.71; p = 0.0071) and maximal PAA angle (HR 1.73/SD, 95% CI 1.018–2.95; p = 0.043) were associated with major amputation/mortality at end of follow-up. Conclusion The majority of patients undergoing ER for PAA were not treated within IFU. Diameter size difference >1 mm between overlapping stent grafts was associated with a higher loss of primary patency at one year. Multi-center studies with larger sample size and long-term follow up of patency are warranted.

scholarly journals Case report: rupture of popliteal artery aneurysm

2015 ◽  
Vol 14 (2) ◽  
pp. 189-192 ◽  
Author(s):  
Altino Ono Moraes ◽  
Rogério Yoshikazu Nabeshima ◽  
Felipe Franchini Rezende ◽  
Ericsson Fernando Viotto ◽  
Claudio Ricardo Bogdan
Keyword(s):  
Popliteal Artery ◽  
Doppler Ultrasonography ◽  
Artery Aneurysm ◽  
Signs And Symptoms ◽  
Popliteal Fossa ◽  
Covered Stents ◽  
Intense Pain ◽  
Popliteal Artery Aneurysm ◽  
Abdominal Aortic ◽  
History Of

An 83-year-old female patient with a history of prior endovascular treatment to repair an abdominal aortic aneurysm presented with intense pain and edema in the left leg, with hyperemia and localized temperature increase. Doppler ultrasonography revealed a voluminous aneurysm of the popliteal artery with a contained rupture, and hematoma involving the popliteal fossa and the medial and anterior surfaces of the knee causing compression of the popliteal vein. Endovascular repair was accomplished with covered stents and the rupture was confirmed. during the procedure The aneurysm was excluded and the signs and symptoms it had caused resolved completely, but during the postoperative period the patient developed sepsis of pulmonary origin and died.

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