Rapid progression of a small penetrating aortic ulcer to rupture in the setting of Staphylococcus aureus bacteraemia

An octogenarian woman with heart failure, atrial fibrillation and asthma was admitted with a cervical phlegmon and methicillin-sensitive Staphylococcus aureus bacteraemia. Initial CT angiography (CTA) showed a small infrarenal penetrating aortic ulcer without rupture, peri-aortic haematoma or pseudoaneurysm and conservative management was adopted. Three weeks later, she developed acute abdominal pain and anaemia. Repeat CTA showed rapid progression of the lesion to a contained rupture. Emergency endovascular repair was performed using a straight AFX VELA infrarenal endograft component. At 18-month follow-up, she had recovered clinically and CTA showed a stable endograft without endoleak or radiological features indicative of stent-graft infection.