A 34-year-old male with a history of infective endocarditis and mitral valve replacement presented with abdominal pain, fever, and leg pain. CT angiography revealed a ruptured common iliac artery aneurysm and femoral mycotic aneurysm. The patient underwent open surgical repair including aneurysm resection, tissue debridement, and grafting of the common iliac artery despite a ureteral injury during surgery. Blood cultures remained negative. The patient was discharged on long-term antibiotics and anticoagulation and followed up in clinic with improved walking.

2. Contained Rupture of Common Iliac Artery, Concomitant with
Contralateral Femoral Mycotic Aneurysm;
Case of Negative Culture Infective Endocarditis
KHALID RAJHI MD
Consultant of Vascular & Endovascular Surgery – Jazan Specialist Hospital
Lead of Vascular Surgery - Ministry of Health, Jazan Province, Kingdom of Saudi Arabia

3. Disclosure
No financial disclosure or conflicts of interest with the
presented material of this presentation

4. • 34 years old Male.
• Past history: Acute infective endocarditits, mitral valve
replacement, warfarin 8 mg daily.
• Negative bacterial and blood culture.
• Antibiotics 21 days.

5. 2 months post valve replacement
Outpatient Visit
• Lower Abdominal pain, fever, Intermittent claudication.
• Physical Examination:
 Vital Signs: Temp 39.3°C
Pulses 138 bpm
BP 124/78 mmHg
RR 22

6. • Normal cardiac examination,
• Painful palpable Right Lower Quadrant
• Lower extremities:
 weak pulses/right side
 ABI Right: 0.88, Left: 1

7. • Lab Results
Hemoglobine 14.2 g/dl
WBCs 18.6 cells/ microliter
C-Reative Protein 114 mg/L
ESR 65 mm / hr

8. CT Angiography

9. Multidisciplinary Discussion
• Antibiotics (Tazocilline + Dalacine).
• Body Scan.
• Surgery : - Autologus venous graft
- Prosthetic Graft ( rifampicine soaked )

10. Operation Theatre
Open surgical repair OSR, medline incision, infraumblical
• Aneurysmal resection.
• Tissue debridement.
• Right ureteral injury (ureteral double J stent implantation).
• Ligation of right common iliac artery, right hypogastric artery
and left profunda femoris.

11. • ABI post OP 0.88
• Blood / Tissue culteres –ve
• Discharged on a long-term, broad-spectrum antibiotics and an
anticoagulant.
• Patient followed in outpatient clinic with an improvement of
walking distance.
• Double J stents removed 45 days.

12. CTA post OP

13. Conclusion
• A contained rupture of mycotic aortic aneurysm can lead to a
serious hemodynamic compromise when it becomes
uncontained, hence, it should be managed as urgent as
patient’s general condition stable.
• Recommendations of a prompt surgery for all patients
irrespective of the size of the aneurysm.
Sörelius K, et al Eur J Vasc Endovasc Surg. 2019
Raman SP, et al Emerg Radiol. 2014

14. • Patient’s condition and life expectancy and are factors to be
considered in choosing a repair approach despite the
complications associated with both open surgical and
endovascular repair.
• Prolonged antibiotic therapy improve survival with favorable
outcome.
Wilson WR, et al Circulation. 2016