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Background <p>Infective native aorto-iliac aneurysms and pseudoaneurysms are uncommon but life-threatening vascular infections. In rupture-prone presentations, emergency endovascular aneurysm repair (EVAR) may be required to reduce the immediate risk of hemorrhage, but technical exclusion of the aneurysm does not establish infection control.</p> Case presentation <p>We report three patients with rupture or impending rupture of infective native aorto-iliac aneurysms who underwent emergency EVAR followed by post-procedural reassessment for residual infection. Case 1 was a 66-year-old woman with type 2 diabetes who presented with lower abdominal pain, leukocytosis, elevated C-reactive protein, and a gas-containing left common iliac pseudoaneurysm. Blood anaerobic culture grew <i>Klebsiella pneumoniae</i> with susceptibility to imipenem, meropenem, ceftazidime, cefoperazone-sulbactam, and ceftazidime-avibactam, while urine cultures were negative. Although endovascular exclusion was technically successful, persistent inflammatory signals prompted reassessment and subsequent source-control management. Perforated appendicitis with retroperitoneal contamination supported appendiceal-source contiguous spread to the iliac artery. Case 2 involved a distal abdominal aortic infected pseudoaneurysm with rupture near the inferior mesenteric artery origin; persistent peri-aortic fluid after EVAR required laparoscopic hematoma evacuation and lesion resection. Case 3 involved an infrarenal infected aortic pseudoaneurysm with bilateral common iliac involvement; delayed fever, <i>Escherichia coli</i> bacteremia, and right iliac limb occlusion led to thrombectomy, which retrieved inflammatory fibrinous debris.</p> Conclusions <p>In infective native aorto-iliac aneurysms, emergency EVAR can control the immediate risk of rupture, but exclusion of the aneurysm does not eradicate infection. After EVAR, persistent fever, pain, elevated inflammatory markers, bacteremia, or peri-graft fluid or gas should prompt a search for a residual or occult gastrointestinal, retroperitoneal, or urinary source. An appendiceal source of <i>Klebsiella pneumoniae</i> iliac pseudoaneurysm is rare, and recognizing it may allow timely source control. The short follow-up and small number of patients limit broader conclusions.</p>

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Appendiceal-source Klebsiella pneumoniae iliac pseudoaneurysm with rupture risk: a three-case series highlighting post-EVAR reassessment

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  • 发表日期：

    2026年7月20日

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  • Bingjing Chen,
  • Jingyu Ji,
  • Yiqing Li,
  • Qin Li,
  • Chao Yang,
  • Yujie Wang

摘要

Background

Infective native aorto-iliac aneurysms and pseudoaneurysms are uncommon but life-threatening vascular infections. In rupture-prone presentations, emergency endovascular aneurysm repair (EVAR) may be required to reduce the immediate risk of hemorrhage, but technical exclusion of the aneurysm does not establish infection control.

Case presentation

We report three patients with rupture or impending rupture of infective native aorto-iliac aneurysms who underwent emergency EVAR followed by post-procedural reassessment for residual infection. Case 1 was a 66-year-old woman with type 2 diabetes who presented with lower abdominal pain, leukocytosis, elevated C-reactive protein, and a gas-containing left common iliac pseudoaneurysm. Blood anaerobic culture grew Klebsiella pneumoniae with susceptibility to imipenem, meropenem, ceftazidime, cefoperazone-sulbactam, and ceftazidime-avibactam, while urine cultures were negative. Although endovascular exclusion was technically successful, persistent inflammatory signals prompted reassessment and subsequent source-control management. Perforated appendicitis with retroperitoneal contamination supported appendiceal-source contiguous spread to the iliac artery. Case 2 involved a distal abdominal aortic infected pseudoaneurysm with rupture near the inferior mesenteric artery origin; persistent peri-aortic fluid after EVAR required laparoscopic hematoma evacuation and lesion resection. Case 3 involved an infrarenal infected aortic pseudoaneurysm with bilateral common iliac involvement; delayed fever, Escherichia coli bacteremia, and right iliac limb occlusion led to thrombectomy, which retrieved inflammatory fibrinous debris.

Conclusions

In infective native aorto-iliac aneurysms, emergency EVAR can control the immediate risk of rupture, but exclusion of the aneurysm does not eradicate infection. After EVAR, persistent fever, pain, elevated inflammatory markers, bacteremia, or peri-graft fluid or gas should prompt a search for a residual or occult gastrointestinal, retroperitoneal, or urinary source. An appendiceal source of Klebsiella pneumoniae iliac pseudoaneurysm is rare, and recognizing it may allow timely source control. The short follow-up and small number of patients limit broader conclusions.