[Advanced Systemic Sclerosis: Endovascular Reconstruction of the Aortic Bifurcation for Limb Salvage]. / Endovaskuläre Rekonstruktion der Aortenbifurkation zum Extremitätenerhalt bei fortgeschrittener systemischer Sklerodermie.

History and admission findings A 69-year-old patient was initially hospitalized because of a 1.5 cm ulceration at the back of the right foot which had existed for the last year and become increasingly swollen and painful. Medical history revealed PmScl-positive systemic sclerosis presenting with a massive calcinosis cutis, advanced pulmonary fibrosis and peripheral artery disease. Examinations Inflammatory markers were normal. MR-Angiography of the lower extremities revealed a multi-segmental high-grade stenosis of the aortic bifurcation due to extensively calcified plaques. Considering the high operative risk and potential excessive scar formation the indication for an interventional procedure was established. Treatment and course After uncomplicated aorto-biiliac stent implantation peripheral pulses had significantly improved and wound debridement led to healing of the ulcer. After additional nutritional advice and caloric substitution the patient was dismissed from the hospital in good condition and without complications. Conclusion Endovascular reconstruction of the aortic bifurcation is a safe alternative to surgery especially when patients present with a severe generalized disease and a high operative risk. Interdisciplinary cooperation is crucial for an optimal treatment regimen.

Ruptured Mycotic Aortic Aneurysm after Bacille Calmette-Guerin Therapy.

To report a case of a ruptured mycotic abdominal aortic aneurysm (MAA) after intravesical Bacille Calmette-Guerin (BCG) therapy because of bladder carcinoma. A 57-year-old male patient was admitted to our hospital for follow-up computed tomography 14 months after transurethral resection of a papillary carcinoma of the bladder and intravesical BCG therapy. The CT scan revealed a ruptured MAA aneurysm and the patient underwent an endovascular repair with an aorto-bi-iliac stent graft. A ruptured MAA is a rare but lethal complication after BCG instillation therapy. The standard therapy is the open reconstruction but according to the literature an endovascular therapy in combination with long-term antibiotics should be considered as a bridging or a definite solution.