Mycotic Common Femoral Artery Pseudoaneurysm from Septic Ankle Arthritis: Surgical and Endovascular Management

Overview

This report details a rare case of a mycotic pseudoaneurysm of the common femoral artery (CFA) caused by hematogenous spread from septic ankle arthritis. Multidisciplinary management included in situ autologous vein graft reconstruction and subsequent endovascular revascularization of distal occlusions, resulting in clinical stabilization.

Background

Mycotic aneurysms are rare vascular infections constituting less than 1% of all aneurysms and carry high risks of rupture, sepsis, and limb loss. They commonly arise from bacteremia or contiguous spread, with Staphylococcus aureus frequently implicated. Traditional treatment involves excision with extra-anatomic bypass, but in situ reconstruction with autologous vein grafts is increasingly favored due to better resistance to reinfection and durability. Endovascular techniques serve as adjuncts in select cases, though infection control remains paramount. Mycotic aneurysms of the CFA are uncommon, especially those secondary to remote musculoskeletal infections.

Data Highlights

Key Findings

• A 78-year-old man developed a large (6.2 cm) mycotic pseudoaneurysm of the right common femoral artery secondary to hematogenous spread from MRSA septic ankle arthritis.
• In situ reconstruction using a reversed autologous femoral vein graft was successfully performed with extensive debridement and sartorius flap coverage.
• Postoperative management included targeted intravenous antibiotics and negative pressure wound therapy for the contaminated groin wound.
• Subsequent endovascular recanalization of chronic popliteal and tibial occlusions was safely achieved via contralateral CFA access to protect the fresh vein graft anastomoses.
• Endovascular treatment involved subintimal passage, drug-coated balloon angioplasty, and placement of three stents, including a drug-eluting stent, resulting in patent graft and improved distal perfusion.

Clinical Implications

This case underscores the importance of a multidisciplinary approach combining open surgical and endovascular techniques for managing complex mycotic pseudoaneurysms. Autologous vein grafts provide durable in situ reconstruction resistant to reinfection. Careful planning of endovascular access is critical to avoid disruption of fresh vascular reconstructions. Early identification and treatment of remote infectious sources, such as septic arthritis, are essential to prevent vascular complications.

Conclusion

Mycotic pseudoaneurysms of the common femoral artery secondary to septic arthritis are rare but can be effectively managed with combined surgical debridement, autologous vein graft reconstruction, and adjunctive endovascular interventions. Multidisciplinary coordination and infection control are key to optimizing outcomes.

References

1. 1. General literature on mycotic aneurysms and pathogens
2. 3-5. Studies supporting in situ autologous vein graft reconstruction
3. 5-6. Data on endovascular adjunctive techniques in infected aneurysms