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Mycotic pseudoaneurysms of the superficial femoral artery (SFA) are rare and are usually secondary to colonization of an atherosclerotic plaque during an episode of bacteremia. We describe the case of a 68 year-old diabetic male who presented to the Emergency Department with pyrexia and a painful expanding mass in the left thigh. He had a history of diarrhea and had been treated 16 days earlier for an SFA pseudoaneurysm that had been excluded with a covered stent with no adjunctive antibiotic therapy. Angio CT showed an abscess surrounding femoral vessels and stent thrombosis. Under general anesthesia, we performed extensive debridement, removal of the endovascular material, SFA ligation, and empirical antibiotic therapy. Blood and tissue cultures were positive for Escherichia coli. At the 3-months follow up visit, the patient reported he had no claudication. In selected patients, mycotic pseudoaneurysms can be treated by SFA ligation.

Background and objective In patients with peripheral artery disease requiring surgery, anaemia has been found to independently predict short and medium term higher morbidity and mortality. Patients and methods We retrospectively studied all patients undergoing surgery, consecutively during 2 months in 12 vascular surgery units. We analyzed cardiovascular risk factors and preoperative hemoglobin. Statistical analysis was done with Kaplan–Meier for survival and logistic regression modeling to identify predictors of mortality. Results 518 patients were consecutively operated on in our vascular units, the mortality rate was 21% the first year and 34% for cardiovascular events. Preoperative anaemia was present in 63% of the ischemic patients and in 23% of the patients requiring aneurysm repair, one year after surgery it increased to 68% and 50% respectively. When preoperative anaemia was superior to 10 mg/dl, one year survival increased (96% vs. 90%), fewer cardiovascular events occurred and there were fewer amputations (24% vs. 68%). Conclusions On multivariable analysis: age, renal failure, chronic lung disease, coronary artery disease, postoperative complications and previous cardiovascular events were associated with an increased risk mortality rate. Preoperative hemoglobin influenced proportionally such that for every 1 mg/dl increase, the probability of mortality decreases by 0.81. Preoperative anaemia, especially when hemoglobin is inferior to 10 mg/dl, is associated with an increased risk of death and amputation.

Resumen Antecedentes y objetivos En los pacientes con enfermedad arterial periferica que requieren intervenciones quirurgicas la anemia se ha comprobado que puede ser un factor independiente de mal pronostico tanto a corto como a medio plazo. Pacientes y metodos Revision retrospectiva de los pacientes intervenidos en cirugia vascular de forma consecutiva durante 2 meses en 12 unidades de cirugia vascular. Se analizan los factores de riesgo habituales y se valora la hemoglobina (Hb) preoperatoria. Con un seguimiento de 12 meses, se registran eventos cardiovasculares, muerte y cifras de Hb. El analisis de supervivencia con tablas de Kaplan-Meier y, posteriormente, analisis de regresion logistica para evaluar los factores que pueden influir en la mortalidad. Resultados En 518 pacientes, la mortalidad al ano es del 21% y los eventos cardiovasculares del 34%. La anemia preoperatoria fue del 63% en isquemicos y el 23% en aneurismas, siendo superior al ano de la cirugia, el 68 y el 50%, respectivamente. Si la Hb preoperatoria es mayor de 10 mg/dl, la supervivencia al ano es mayor (96% vs. 90%), se producen menos eventos cardiovasculares y menos amputaciones (24% vs. 68%). Conclusiones En el analisis multivariante, las variables que influyeron en la mortalidad fueron la edad, la insuficiencia renal, la enfermedad pulmonar obstructiva cronica, la cardiopatia isquemica, haber presentado complicaciones hospitalarias, tener un evento cardiovascular. La Hb preoperatoria influye proporcionalmente, de manera que cada unidad de Hb que aumenta, disminuye la probabilidad de muerte 0,81 veces. Una anemia con Hb preoperatoria inferior a 10 se asocia a una mayor probabilidad de amputacion de la extremidad y de fallecimiento.