Percutaneous graft stent closure of a Profunda femoris mycotic aneurysm secondary to infective endocarditis: a case report

Mycotic aneurysms are rare complications of infective endocarditis, occurring in ∼2% of cases and often associated with high morbidity and mortality. Femoral, carotid, and iliac arteries are most commonly affected. When this complication arises, it further complicates the management and treatment of infective endocarditis, which is already a challenging condition to treat.

We report a 34-year-old male with a history of mechanical mitral valve replacement who presented with fever, fatigue, and loss of appetite. Due to a high clinical suspicion of infective endocarditis, empirical antibiotics were initiated accordingly. Blood cultures yielded Pseudomonas aeruginosa, and transoesophageal echocardiography revealed vegetation on the mitral prosthetic valve, confirming infective endocarditis. During hospitalization, the patient developed acute leg pain and a drop in haemoglobin levels. Computed tomography angiography revealed a large mycotic aneurysm of the right profunda femoris artery. Due to haemodynamic instability and suspected impending rupture, endovascular treatment was performed using a graft stent. Complete aneurysm exclusion was achieved without complications. The patient completed 8 weeks of intravenous antibiotics. Follow-up imaging confirmed resolution of vegetation, and no abscess or graft infection was observed in the femoral region. He was discharged in stable condition.

Mycotic aneurysms require urgent and aggressive management due to the risk of rupture. While surgical repair remains the standard of care, endovascular approaches such as graft stent placement offer a viable alternative in haemodynamically unstable patients or those with high surgical risk. This case highlights the importance of timely diagnosis, appropriate antibiotic therapy, and individualized interventional planning to achieve favourable outcomes.