An unusual presentation of mycotic aneurysm of popliteal artery and the challenges faced: a case report

Mycotic aneurysm of popliteal artery is a very rare condition, most commonly caused by gram positive organisms. This term was coined by William Osler describing aneurysms associated with bacterial endocarditis. Though cases of peripheral vessel mycotic aneurysm are very rare, it is a dangerous condition as it can go for rupture/ thrombosis. The treatment of choice is resection and revascularization, preferably by using autologous vein graft along with antibiotics. A 35-year-old female who presented with features of cerebrovascular accident, during the course of stay was diagnosed to have mycotic aneurysm of the left popliteal artery. We describe the clinical course, investigation findings and challenges faced in management of the case.

Surgical treatment of carotid artery stent infection: a case report

The most effective treatment for graft infection is still debated, and the success rate of current treatments is low. We herein report the results of surgical treatment and follow-up of a case of infection acquired during carotid stenting with the aim of exploring the most effective treatments for graft infection. We retrospectively analyzed a patient who was admitted in September 2019. This patient underwent debridement, autologous saphenous vein replacement of the common carotid to internal carotid artery, external carotid artery suturing, and continuous negative-pressure wound therapy for carotid stent infection. Ten days after carotid artery revascularization, the growth of granulation tissue in the incision was good, and we decided to suture the neck incision. Five days after removing the stitches, grade A healing was noted. Furthermore, the carotid artery and autologous vein grafts were unobstructed as shown by carotid artery computed tomography angiography reexamination. The patient was monitored for 8 months with no new neurological symptoms and good healing of the incision. Effective treatment of vascular graft infection includes debridement and removal of the infected graft, autologous vein graft revascularization, and negative-pressure wound therapy combined with antibiotic therapy.

Aetiology and Management of Vascular Injuries in Extremity Trauma: An Observational Study

Introduction: Management of peripheral vascular injury is a challenging task. To save life and to salvage the limb, early diagnosis and prompt intervention is required. Aim: To analyse the cause of injury, surgical approach, outcome and complications in patients with peripheral vascular trauma. Materials and Methods: This observational study assessed 60 consecutive patients who were operated for peripheral vascular injuries in the last one and half year (October 2018 to March 2020). Diagnostic tools were clinical examination in combination with vascular Doppler. Vascular repair with interposition autologous vein graft or primary repair was performed. Extensive injury with non-viable limb requiring primary amputation was excluded from the study. The primary outcome in form of limb salvage was selected. Fisher-exact test was used to analyse limb salvage rate between two groups having median revascularisation time less than six hours and more than six hours. Results: In the present study there were 55 male patients (91.6%) out of 60 patients. The mean age was 24.8±7.0 years. The mechanism of injury in 28 (46.6%) cases was blunt trauma and in 32 (53.3%) cases it was penetrating trauma. The associated orthopaedic injury was present in 20 (33.3%) patients. The most commonly injured artery was brachial 26 (43.3%) followed by popliteal 13 (21.6%) and femoral artery nine (15%). Primary repair was performed in 18 (30%) cases and interposition vein graft in 42 (70%) cases. Majority of patients, 53 cases (88.3%) had functional viable limb. Complications found were wound infection in six cases (10%), revision surgery in five cases (8.3%) and secondary amputation in seven cases (11.6%). Median time interval between injury and revascularisation surgery was 9.04 hours. Those who presenting late (>6 hours) had a higher amputation rate but it was not statistically significant. Conclusion: Management of vascular injuries require prompt localisation and early surgical intervention. A successful outcome is seen in patients who were early diagnosed. However, limb salvation is possible, even in patients with delayed presentation.

Aerococcus urinae Aortitis: A Case Report

Background Aerococcus urinae is a Gram-positive coccus that is increasingly recognized as a urinary pathogen since the introduction of mass spectrometry for identification of bacteria. We report a case of abdominal aortitis (with aneurysm) caused by A urinae in a male with recurrent urinary tract infections and recently treated A urinae bacteremia. A 63-year-old gentleman with a history of A urinae urosepsis 7 weeks prior, presented to the Emergency Department with thoracolumbar back pain radiating bilaterally into the groin. Radiological and surgical findings were consistent with infective infrarenal aortitis with aneurysm. Methods The patient successfully underwent open surgical debridement and reconstruction of the infrarenal aorta with autologous vein graft. Results Aerococcus urinae was isolated from excised tissue. The patient completed a 4-week course of intravenous antimicrobial therapy. Conclusions Aurinae is a urinary pathogen with the ability to cause severe invasive disease including endovascular infections.