Brachial Mycotic Pseudoaneurysms Due to Prosthetic Valve Infective Endocarditis: A Case Report and Review of the Literature
Keywords:Infective endocarditis, brachial artery, pseudoaneurysm
Brachial mycotic pseudoaneurysms (BMPA) are a rare complication of infective endocarditis (IE), but potentially could be a limb-threatening condition. We present the case of a 38-year-old male referred to our department, complaining of the sudden onset of a painful pulsatile mass 5 x 10 cm in the right antecubital fossa that slowly progressed over time. Two years before this, he underwent aortic and mitral valve replacement with mechanical prosthetic valves and tricuspid annuloplasty for IE with methicillin-susceptible
Staphylococcus aureus after a six-week course of intravenous antibiotherapy with oxacillin. Clinical examination of the right upper limb revealed a pulsatile and compressible mass with a normal temperature and without other clinical signs of inflammation. Pulse of the axillary artery, brachial and radial arteries were palpable. He was diagnosed by Doppler ultrasonography and digital subtraction angiography with BMPA.
Furthermore, transesophageal echocardiography (TEE) revealed normal function of the aortic and mitral prosthetic valve with no signs of prosthetic valve endocarditis and no feature of congestive heart failure. Considering these clinical findings, surgical treatment was planned. He underwent re-section of the brachial pseudoaneurysm and arterial reconstruction. One year after the pseudoaneurysm resection, evolution was excellent. This manuscript presents this rare, uncommon complication after IE and also reviews the available surgical management strategies for this pathology.
Brown SI, Busuttil RW, Baker JD, Machleder HI, et al. 1984. Bacteriologic and surgical determi-nants of survival in patients with mycotic aneurysms. J Vasc Surg 1:541e547.
Cakalagaoglu C, Keser N, Alhan C. 1999. Brucella-mediated prosthetic valve endocarditis with brachial artery mycotic aneurysm. J Heart Valve Dis 8:586-590.
Gonzalez I, Sarria C, Lopez J, Vilacosta I, et al. 2014. Symptomatic peripheral mycotic aneurysms due to infective endocarditis: a contemporary profile. Medicine Baltimore 93:42-52.
Gürel K, Gür S, Özkan U, Tekbaş G, et al. 2012. US-guided percutaneous thrombin injection of post catheterization pseudoaneurysms. Diagn Interv Radiol 18:319-25.
Leon LR, Psalms SB, et al. 2008. Infected Upper Extremity Aneurysms. A Review. Eur J Vasc En-dovasc Surg 35:320-331.
Mylonakis E, Calderwood SB. 2001. Infective endocarditis in adults. N Engl J Med 345:1318-1330.
Nishimura K, Hamasaki T, Yamamoto S, Kawai T, Sugiura K. 2015. Endovascular treatment of left subclavian artery pseudoaneurysm after clavicle fracture in an elderly adult with a 40-year history of Behçet's disease. Ann Vasc Dis 8:328-30.
Osler W. 1885. The Gulstonian Lectures on malignant endocarditis. Br Med J 1:467.
Patra P, Ricco J, Costargent A, Goueffic Y, et al. 2001. Association Universitaire de Recherche en Chirurgie (AURC). Infected aneurysms of neck and limb arteries: a retrospective multicenter study. Ann Vasc Surg 15:197-205.
Stengel A, Wolferth CC. 1923. Mycotic (bacterial) aneurysms of intravascular origin. Arch Intern Med (Chic) 31(4):527-554.
Stiru O, Geana CR, Pavel P, Croitoru M, Boros C, Iovu I, Iliescu, V. 2018. Descending thoracic aortic aneurysm rupture treated with thoracic endovascular aortic repair in a patient with peripheral artery disease. The Heart Surgery Forum 21(2): E112-E116.
Tsao JW, Marder SR, Goldstone J, et al. 2002. Presentation, diagnosis, and management of arterial mycotic pseudoaneurysms in injection drug users. Ann Vasc Surg 16:652-62.