Ruptured infected external iliac artery aneurysm following total hip arthroplasty successfully treated with endovascular stent graft placement: A case report

<h2>Abstract</h2> Although rare, infected aneurysm formation following hip arthroplasty is a serious complication that can be life-threatening. The current patient was a 58-year-old woman who had undergone left hip arthroplasty 7 years earlier and bilateral hip arthroplasty 3 years earlier. She presented with pain in her left lower leg. She was diagnosed with left hip joint dislocation and admitted for revision surgery. After admission blood tests revealed elevated inflammatory markers and progressive anemia, and worsening swelling and pain in the left lower leg. Computed tomography revealed a ruptured aneurysm of the left external iliac artery. It was hypothesized that a periprosthetic joint infection had contributed to the development and rupture of the aneurysm. She underwent endovascular therapy using a stent graft. The infected artificial hip joint was then surgically removed, and antimicrobial therapy was administered. Her condition improved after treatment. One of the major concerns with stent graft treatment in infected aneurysms is the persistence of infected tissue. While endovascular therapy can be effective, debridement of infected lesions remains the standard approach for long-term infection control. We suggest that stent graft placement may be a viable treatment option in selected cases. <h3>Learning objective</h3> Infected aneurysm formation after hip arthroplasty is rare. In the current emergent case of aneurysmal rupture, considering the patient's overall condition, we initially opted for endovascular stent graft placement. In the event that the infection was not controlled, secondary surgical replacement with an artificial graft was planned. The case demonstrates the potential utility of such a staged treatment strategy.