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Successful treatment of a mycotic pseudoaneurysm of the brachial artery with percutaneous ultrasound-guided thrombin injection and antibiotics


Poloczek, A; Amann-Vesti, B; Thalhammer, C; Meier, T; Husmann, M (2010). Successful treatment of a mycotic pseudoaneurysm of the brachial artery with percutaneous ultrasound-guided thrombin injection and antibiotics. VASA, 39(2):181-183.

Abstract

We report the case of a 48 year old male with human immuno-deficiency virus and hepatitis C virus infection and previous grafting of a thoracic aortic aneurysm. He returned from a trip to India with fever and in a poor physical condition. Diagnostic work-up revealed septicaemia with staphylococcus aureus, infection of the aortic graft with covered rupture of the proximal anastomosis and mitral valve endocarditis. Following antibiotic therapy, implantation of a transcutaneous endovascular aortic prosthesis and mitral valve repair were performed. During the postoperative period, the patient complained of pain and a palpable pulsating mass in the right cubital fossa. Ultrasound scan revealed a pseudoaneurysm at the brachial artery bifurcation. Since there were no signs of venous puncture in this area, we assumed this to be a mycotic pseudoaneurysm resulting from septic embolism. In the absence of clinical signs of inflammation, this pseudoaneurysm was successfully treated by ultrasound-guided thrombin injection. Irrespective of the cause for this mycotic pseudoaneurysm of the brachial artery, percutaneous ultrasound-guided thrombin closure in combination with antibiotic therapy might be a feasible, safe, cheap and minimally-invasive alternative to surgery.

We report the case of a 48 year old male with human immuno-deficiency virus and hepatitis C virus infection and previous grafting of a thoracic aortic aneurysm. He returned from a trip to India with fever and in a poor physical condition. Diagnostic work-up revealed septicaemia with staphylococcus aureus, infection of the aortic graft with covered rupture of the proximal anastomosis and mitral valve endocarditis. Following antibiotic therapy, implantation of a transcutaneous endovascular aortic prosthesis and mitral valve repair were performed. During the postoperative period, the patient complained of pain and a palpable pulsating mass in the right cubital fossa. Ultrasound scan revealed a pseudoaneurysm at the brachial artery bifurcation. Since there were no signs of venous puncture in this area, we assumed this to be a mycotic pseudoaneurysm resulting from septic embolism. In the absence of clinical signs of inflammation, this pseudoaneurysm was successfully treated by ultrasound-guided thrombin injection. Irrespective of the cause for this mycotic pseudoaneurysm of the brachial artery, percutaneous ultrasound-guided thrombin closure in combination with antibiotic therapy might be a feasible, safe, cheap and minimally-invasive alternative to surgery.

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Additional indexing

Other titles:Erfolgreicher Verschluss eines mykotischen Pseudoaneurysmas der A. brachialis durch perkutane, Ultraschall-gesteuerte Thrombin-Injektion und antibiotische Therapie
Item Type:Journal Article, refereed, original work
Communities & Collections:04 Faculty of Medicine > University Hospital Zurich > Clinic for Angiology
Dewey Decimal Classification:610 Medicine & health
Language:English
Date:2010
Deposited On:17 Aug 2010 06:57
Last Modified:05 Apr 2016 14:13
Publisher:Hans Huber
ISSN:0301-1526
Publisher DOI:https://doi.org/10.1024/0301-1526/a000025
PubMed ID:20464675
Permanent URL: https://doi.org/10.5167/uzh-35397

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