PMC5349451_01
Pre-operative axial images from computed tomography demonstrating (A) a right iliopsoas abscess measuring 7 x 5 x 4 cm, (B) a distended and hyperemic Appendix along with a pseudo aneurysm arising from the lateral wall of the right external iliac artery measuring 9 x 7 mm. Additionally, (C) infection is seen tracking into the right groin precluding the right common femoral artery as a site for distal revascularization.
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Appendix along with a pseudo aneurysm arising from the lateral wall of the right external iliac artery measuring 9 x 7 mm (Fig. 1B). Additionally, infection is seen tracking into the right groin (Fig. 1C). After consultations by vascular surgery, general surgery, infectious diseases and interventional radiology, the plan was to proceed with percutaneous drainage of the abscess, antibiotic therapy and subsequent repair of the pseudoaneurysm. Due to infection tracking into the right groin and adjacent to right common femoral artery (Fig. 1C), we intentionally chose to expose the more distal superficial femoral artery.
Successful computed tomography guided drainage (A) and placement of 12 French Dawson Mueller tube (B) in right iliopsoas abscess with immediate return of hemorrhagic fluid concerning for contained rupture of right external iliac pseudo aneurysm.
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Under conscious sedation and CT guidance, a 12 French x 25 cm Dawson-Mueller Drainage Catheter (Cook Medical, Bloomington, IN) was inserted into the right iliopsoas collection (Fig. 2A & B).
Digital subtraction angiography (DSA) demonstrating a right external iliac artery pseudo aneurysm pre- and post-embolization, respectively (A & B).
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Digital subtraction angiography (DSA) was used to confirm the location of the right external iliac artery pseudoaneurysm (Fig. 3A). Paul, MN) (Fig. 3B) placed proximally and distally to the pseudoaneurysm.
Digital subtraction angiography (A) and three-dimensional volume-rendered images (B) demonstrating successful embolization of the right external iliac artery pseudoaneurysm with Amplatzer I plugs (St. Jude Medical, St. Paul MN) and left common femoral to right superficial femoral bypass with cryopreserved cadaveric femoral vein.
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Follow-up angiography and volume rendered images demonstrate the unconventional graft tunnel (Fig. 4A & B) need to avoid the infectious fluid in the right groin.
Post-operative axial images from computed tomography demonstrating a nearly resolved right iliopsoas abscess and successful exclusion of infected right external iliac artery pseudoaneurysm (A-C).
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Following continued catheter drainage and prolonged antibiotic therapy (ertapenem and fluconazole), the patient's intra-abdominal infection resolved (Fig. 5A-C).