A Rare Case of Mycotic Common Femoral Artery Pseudoaneurysm from Septic Ankle Arthritis: Surgical and Endovascular Considerations

Purpose: Mycotic aneurysms are rare, life-threatening vascular infections that typically result from direct vascular inoculation, including intravenous drug use or vascular access procedures. Hematogenous seeding from a remote musculoskeletal source is distinctly uncommon. This report describes the multidisciplinary management of a mycotic common femoral artery pseudoaneurysm arising from septic ankle arthritis, highlighting key open and endovascular considerations. Case Report: A 78-year-old man presented with painful right-groin swelling and septic right-ankle arthritis. Computed tomographic angiography demonstrated a mycotic pseudoaneurysm of the right common femoral artery, and blood and operative cultures grew methicillin-resistant Staphylococcus aureus . He underwent debridement of the infected groin and in situ reconstruction using a reversed femoral vein interposition graft through combined retroperitoneal and thigh exposures. Due to contamination, the groin required secondary wound healing. Chronic popliteal and tibial occlusions were subsequently treated with staged endovascular recanalization and selective stenting using contralateral up-and-over access to avoid stress on the fresh anastomoses. The patient completed a 6-week course of antibiotics, with complete wound healing and return to independent function. Conclusion: This case demonstrates the effective combination of autologous in situ femoral vein reconstruction and staged endovascular revascularization for a mycotic pseudoaneurysm in the setting of bacteremia. Multidisciplinary coordination, careful operative sequencing, and rigorous infection control were essential to achieving durable limb salvage. Clinical Impact In select cases, complex mycotic aneurysms with peripheral vascular disease can be managed with a staged hybrid approach that combines vascular reconstruction with endovascular intervention, reducing the need for multiple open procedures. Employ a multidisciplinary approach with careful sequencing and access planning to protect grafts, control infection, and optimize limb salvage.