Diagnostic and Management Challenges of Subclavian Artery Aneurysms in the Setting of Methicillin-Resistant <i>Staphylococcus aureus</i> Bacteremia and Upper Extremity Deep Vein Thrombosis
<b>Background:</b> Mycotic aneurysms of the subclavian artery are infrequent and pose significant diagnostic challenges, particularly in the context of recurrent methicillin-resistant <i>Staphylococcus aureus</i> (MRSA) bacteremia. The concomitant presence of upper extremity...
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MDPI AG
2025-03-01
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| Series: | Journal of Vascular Diseases |
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| Online Access: | https://www.mdpi.com/2813-2475/4/2/12 |
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| author | Lifei Zhu Milan Regmi Syed S. Fatmi |
| author_facet | Lifei Zhu Milan Regmi Syed S. Fatmi |
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| collection | DOAJ |
| description | <b>Background:</b> Mycotic aneurysms of the subclavian artery are infrequent and pose significant diagnostic challenges, particularly in the context of recurrent methicillin-resistant <i>Staphylococcus aureus</i> (MRSA) bacteremia. The concomitant presence of upper extremity deep vein thrombosis (UEDVT) further complicates the management of bleeding risk and the necessity for anticoagulation therapy. <b>Methods:</b> This report discusses a 75-year-old male patient with a medical history of lung and skin cancer undergoing immunotherapy who presented with a swollen and painful right arm. Ultrasound examination identified deep vein thrombosis in the right axillary and basilic veins, and blood cultures confirmed MRSA infection. Subsequent imaging revealed bilateral subclavian artery aneurysms with contained ruptures involving previously placed stent grafts. Emergent endovascular interventions were performed to prevent catastrophic hemorrhage. <b>Results</b>: Despite the initial interventions, concerns regarding infected stent grafts persisted due to ongoing MRSA bacteremia and the presence of an endoleak. The complexity of balancing anticoagulation for DVT with the risk of aneurysm rupture necessitated the patient’s transfer to a tertiary care center for potential open surgical debridement. <b>Conclusions:</b> This case underscores the diagnostic and therapeutic challenges associated with the simultaneous occurrence of vascular infection, thrombosis, and aneurysmal pathology. Although emergency endovascular repair provided temporary hemostatic control, definitive management may require graft removal if stent infection is confirmed. Optimal care in such complex clinical scenarios demands a multidisciplinary approach and may necessitate advanced surgical interventions. |
| format | Article |
| id | doaj-art-2bc147b3dc6e411bab82ff27a56c73d1 |
| institution | Matheson Library |
| issn | 2813-2475 |
| language | English |
| publishDate | 2025-03-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Journal of Vascular Diseases |
| spelling | doaj-art-2bc147b3dc6e411bab82ff27a56c73d12025-06-25T14:03:56ZengMDPI AGJournal of Vascular Diseases2813-24752025-03-01421210.3390/jvd4020012Diagnostic and Management Challenges of Subclavian Artery Aneurysms in the Setting of Methicillin-Resistant <i>Staphylococcus aureus</i> Bacteremia and Upper Extremity Deep Vein ThrombosisLifei Zhu0Milan Regmi1Syed S. Fatmi2Graduate Medical Education Transitional Year Program, Southeast Health Medical Center, Dothan, AL 36301, USAGraduate Medical Education Internal Medicine Program, Southeast Health Medical Center, Dothan, AL 36301, USAGraduate Medical Education Internal Medicine Program, Southeast Health Medical Center, Dothan, AL 36301, USA<b>Background:</b> Mycotic aneurysms of the subclavian artery are infrequent and pose significant diagnostic challenges, particularly in the context of recurrent methicillin-resistant <i>Staphylococcus aureus</i> (MRSA) bacteremia. The concomitant presence of upper extremity deep vein thrombosis (UEDVT) further complicates the management of bleeding risk and the necessity for anticoagulation therapy. <b>Methods:</b> This report discusses a 75-year-old male patient with a medical history of lung and skin cancer undergoing immunotherapy who presented with a swollen and painful right arm. Ultrasound examination identified deep vein thrombosis in the right axillary and basilic veins, and blood cultures confirmed MRSA infection. Subsequent imaging revealed bilateral subclavian artery aneurysms with contained ruptures involving previously placed stent grafts. Emergent endovascular interventions were performed to prevent catastrophic hemorrhage. <b>Results</b>: Despite the initial interventions, concerns regarding infected stent grafts persisted due to ongoing MRSA bacteremia and the presence of an endoleak. The complexity of balancing anticoagulation for DVT with the risk of aneurysm rupture necessitated the patient’s transfer to a tertiary care center for potential open surgical debridement. <b>Conclusions:</b> This case underscores the diagnostic and therapeutic challenges associated with the simultaneous occurrence of vascular infection, thrombosis, and aneurysmal pathology. Although emergency endovascular repair provided temporary hemostatic control, definitive management may require graft removal if stent infection is confirmed. Optimal care in such complex clinical scenarios demands a multidisciplinary approach and may necessitate advanced surgical interventions.https://www.mdpi.com/2813-2475/4/2/12mycotic aneurysmsubclavian arteryMRSA bacteremiaupper extremity deep vein thrombosiscase report |
| spellingShingle | Lifei Zhu Milan Regmi Syed S. Fatmi Diagnostic and Management Challenges of Subclavian Artery Aneurysms in the Setting of Methicillin-Resistant <i>Staphylococcus aureus</i> Bacteremia and Upper Extremity Deep Vein Thrombosis Journal of Vascular Diseases mycotic aneurysm subclavian artery MRSA bacteremia upper extremity deep vein thrombosis case report |
| title | Diagnostic and Management Challenges of Subclavian Artery Aneurysms in the Setting of Methicillin-Resistant <i>Staphylococcus aureus</i> Bacteremia and Upper Extremity Deep Vein Thrombosis |
| title_full | Diagnostic and Management Challenges of Subclavian Artery Aneurysms in the Setting of Methicillin-Resistant <i>Staphylococcus aureus</i> Bacteremia and Upper Extremity Deep Vein Thrombosis |
| title_fullStr | Diagnostic and Management Challenges of Subclavian Artery Aneurysms in the Setting of Methicillin-Resistant <i>Staphylococcus aureus</i> Bacteremia and Upper Extremity Deep Vein Thrombosis |
| title_full_unstemmed | Diagnostic and Management Challenges of Subclavian Artery Aneurysms in the Setting of Methicillin-Resistant <i>Staphylococcus aureus</i> Bacteremia and Upper Extremity Deep Vein Thrombosis |
| title_short | Diagnostic and Management Challenges of Subclavian Artery Aneurysms in the Setting of Methicillin-Resistant <i>Staphylococcus aureus</i> Bacteremia and Upper Extremity Deep Vein Thrombosis |
| title_sort | diagnostic and management challenges of subclavian artery aneurysms in the setting of methicillin resistant i staphylococcus aureus i bacteremia and upper extremity deep vein thrombosis |
| topic | mycotic aneurysm subclavian artery MRSA bacteremia upper extremity deep vein thrombosis case report |
| url | https://www.mdpi.com/2813-2475/4/2/12 |
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