MYCOTIC-ANEURYSM OF THE COMMON ILIAC ARTERY AND DISTAL AORTA FOLLOWING STENT PLACEMENT

A 43-year-old man was evaluated for disabling left leg claudication, A ortography demonstrated occlusion of the left common and external ilia c arteries with reconstitution of the left common femoral artery. Duri ng this procedure a 10 mm x 9.4 cm Wallstent was placed from the proxi mal common iliac to the mid-external iliac artery followed by a 10 mm Palmaz stent placed proximal to the Wallstent. He returned after 2 wee ks with recurrent symptoms and an absent left femoral pulse. Repeat ao rtography confirmed that the stented iliac artery was thrombosed. Foll owing thrombolysis, a stenosis distal to the Wallstent was identified and another 8 mm x 4 cm Wallstent was inserted to dilate the stenotic lesion. He did well until the following week when he returned complain ing of fever, anorexia, and low back pain. Staphylococcus aureus was c ultured from the blood. An initial computed tomography (CT) scan demon strated only Inflammation around the distal aorta, but owing to unremi tting fever and symptoms, he underwent another CT scan 4 days later, w hich demonstrated a large aneurysm of the distal aorta and left common iliac artery. The patient was taken to the operating room where a rig ht-to-left femorofemoral bypass was performed. After the groin wounds were closed, an exploratory laparotomy disclosed a large mycotic aneur ysm of the distal aorta and proximal left common iliac artery. The aor ta was oversewn below the level of the inferior mesenteric artery (IMA ) and the Palmaz and proximal Wallstent were removed. An IMA thrombect omy was performed because no Doppler flow was present in the sigmoid m esentery. Following abdominal closure, a right axillofemoral graft and thrombectomy of the femorofemoral graft were performed. On postoperat ive day 12, he developed an ileus and signs of sepsis. Upon reexplorat ion, a sigmoid perforation was discovered and a sigmoid resection and colostomy were performed. He was treated with parenteral antibiotics a nd enteral nutrition and was transferred for continued rehabilitation 8 weeks later.