title: Arterial reconstruction for atypical mycotic aneurysms.
abstract: Our case involves a 67-year-old man with a  post lung transplantation status for idiopathic pulmonary fibrosis, who was initially referred to our institution for treatment of left hip septic arthritis due to Pseudallescheria boydii infection. One month following total hip arthroplasty, he noticed left upper thigh swelling with duplex imaging consistent with a 7-cm mid-superficial femoral artery aneurysm with popliteal vein compression and associated deep venous thrombosis. During operative resection, exploration of his contralateral saphenous vein showed inadequate conduit for use. Therefore, we proceeded with proximal and distal clamp control with intraoperative arterial shunting followed by cryoarterial reconstruction after complete aneurysm sac resection and debridement. Intraoperative arterial wall cultures remained negative for bacterial pathogens; however, final operative fungal cultures once again grew Pseudallescheria boydii. Our case highlights the complexity of adequate source control with effective arterial reconstruction in these immunosuppressed patient populations, particularly with fungal organisms that historically have poor therapeutic response to medical therapy alone.
authors.affiliation: Loyola University Medical Center, Vascular Division, Maywood, IL 60153, USA. mmalinowski@lumc.edu
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Malinowski
authors.forename: Pegge
authors.initials: P
authors.lastname: Halandras
mesh_terms: D000785:Aneurysm, Infected / Q000175:diagnosis / Q000382:microbiology / Q000601:surgery*; D000935:Antifungal Agents / Q000627:therapeutic use; D003646:Debridement; D005263:Femoral Artery / Q000000981:diagnostic imaging / Q000382:microbiology / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009181:Mycoses / Q000175:diagnosis / Q000382:microbiology / Q000601:surgery*; D011541:Pseudallescheria / Q000302:isolation & purification*; D019651:Plastic Surgery Procedures; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D014656:Vascular Surgical Procedures
chemical_list: D000935:Antifungal Agents