A staged, endovascular approach to treat a ruptured external iliac artery mycotic pseudoaneurysm in an intravenous drug user: A case report

•Initial hybrid approach to achieve haemorrhagic and sepsis control is a viable option as a bridge to delayed definitive arterial reconstruction .•Endovascular stent-grafting provides an alternative treatment strategy to arterial ligation in cases of ruptured mycotic pseudoaneurysms.•Anticipation of stent-graft infection can allow time to plan for delayed arterial reconstruction.•Subsequent stent-graft removal and reconstruction can preclude complications of arterial ligation, including claudication and limb-loss.

IntroductionRuptured mycotic pseudoaneurysms are one of the ways IVDU patients can present in extremis. The principles of treatment include arterial ligation for haemorrhage control but can leave patients vulnerable subsequent limb ischaemia.Presentation of caseWe report a female IVDU presenting with abdominal pain and sepsis. Imaging demonstrated haemorrhage from an external iliac pseudoaneurysm. A two-staged hybrid approach with initial endografting and debridement for sepsis-control followed by delayed endograft removal and arterial reconstruction was successfully undertaken.DiscussionThe primary use of endovascular techniques to control haemorrhage in unstable patients is a useful adjunct to treat ruptured mycotic pseudoaneurysms in IVDU patients with delayed removal and arterial reconstruction.ConclusionWe have shown a successful outcome in managing a challenging patient using endovascular techniques as a bridge to definitive arterial reconstruction. This circumvents traditional approaches including primary arterial ligation, which carry a risk of limb-loss.