Rapidly progressive popliteal artery aneurysm with fistula into the venous system as a rare complication of infective endocarditis

Overview

Introduction: Infective endocarditis (IE) is a serious disease with a high mortality rate. Complications of IE are frequent and serious, most of them manifesting as various forms of ischemia. Its rare, but equally serious complications include development of mycotic pseudoaneurysms of peripheral arteries. Total incidence of these aneurysms in connection with IE is approximately 2%. Out of this number, the majority affect intracranial arteries, while the remaining lesions occur equally in visceral and limb locations. We present a case report of a rapidly progressing popliteal artery aneurysm with a fistula into the venous system in a patient after mitral valve replacement.

Case: We present the case of a 70-year-old man with a history of diabetes, hypertension, and post-STEMI who underwent mitral valve replacement for infective endocarditis. A complication occurred postoperatively in the form of a multidrug-resistant polymicrobial respiratory infection. Ten days after transfer to the local hospital from the cardiovascular center, deep vein thrombosis of the right lower extremity developed despite effective anticoagulation. Subsequent diagnostics revealed a rapidly progressing aneurysm of the popliteal artery with destruction of the vascular wall and arteriovenous fistula. The patient underwent urgent resection and reconstruction of the artery and deep vein with autologous vein grafts. The case demonstrates rapidly progressive complication of polymicrobial sepsis after infective endocarditis emphasizing the need for early diagnosis and aggressive surgical and antimicrobial therapy for mycotic aneurysms.

Results: Autologous vein replacement in mycotic aneurysm is considered the method of choice. However, regular lifelong follow-up is necessary to monitor possible late complications.

Keywords:

infective endocarditis – case report – mycotic aneurysm – popliteal artery