Pain in the groin: mycotic aneurysm after transcutaneous aortic valve replacement

Description

An 88-year-old man with controlled hypertension, coronary artery disease and atrial fibrillation on warfarin therapy presented to the emergency department for evaluation of a right groin pain and fall. He had undergone a transcatheter aortic valve replacement (TAVR) for severe aortic stenosis a month prior to presentation. The procedure was complicated by a cerebrovascular accident. He was febrile and tachycardic, with a right-sided ptosis, facial droop and a pulsatile mass in the right groin (access site during TAVR). Laboratory evaluation revealed mild leucocytosis (12, 4.23–9.07 x10⁹/L). A new right common femoral mycotic aneurysm was confirmed on abdominal CT (figures 1 and 2) and ultrasound (figure 3). Within 12 hours, blood cultures grew gram-negative rods, later speciated to Pseudomonas aeruginosa. He was started on empiric vancomycin and piperacillin–tazobactam for suspected sepsis. Evaluation for endocarditis with a transoesophageal echocardiogram did not reveal valvular vegetations. He underwent an...

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