Pseudoaneurysm Leading to Necrotizing Fasciitis at the Femoral Arterial Puncture Site
A 78-year-old man with ischemic heart disease underwent cardiac catheterization and percutaneous transluminal coronary angioplasty via the femoral artery. His premorbid condition included old age, liver cirrhosis, renal cell carcinoma, diabetes mellitus, and significant ischemic cardiomyopathy. Six days following discharge from the hospital, the patient experienced severe sharp pain in the right groin with no skin discoloration of the right lower extremity. On physical examination, a pulsatile mass was noted in the right groin. Lower-extremity angiography revealed a PA of the superficial femoral artery (). Hematoma removal and bleeder ligation were performed by a vascular surgeon. The affected part of the superficial femoral artery was freed, the aneurysm was opened along its length, and the thrombus was evacuated. A heparin infusion was begun postoperatively.\nFive days later, the patient developed progressive abdominal pain, fever, vomiting, skin discoloration, and wound induration (). A laboratory study revealed that the white blood cell count was 2000/µL, erythrocyte sedimentation rate (ESR) level was 11 mm/hr, and reactive protein-C (CRP-C) level was 17.91 mg/dL; all these were mildly elevated values. Further, the creatine kinase-MB (CK-MB) level was in the normal range, but the myoglobin level was elevated to 174 ng/mL (normal range, 22-75 ng/mL). The sodium level was found to be 132 mmol/L (normal range, 135-153 mmol/L), a slightly lowered level, and blood urea nitrogen (BUN) was 25.6 mg/dL (normal range, 8-20 mg/dL). Computed tomographic scans of the abdomen and perineal region revealed fluid accumulations involving multiple subcutaneous spaces and the peritoneum. The patient also had ileus of multiple bowel loops (). At that time, he was diagnosed with necrotizing fasciitis of the upper thigh, abdomen, and perineum. The necrotic wound was serially excised, and treatment was performed with the VAC device. VAC therapy was conducted for a period of 12 days (). The patient had an uneventful recovery with a normal range of laboratory results and finally underwent wound closure ().