Common femoral artery pseudoaneurysm due to Mycobacterium Bovis infection following intravescical bacillus Calmette-Guerin therapy

Vascular complications following the intravesical instillation of Bacillus Calmette-Guerin (BCG) for bladder carcinoma are rare. Large diameter arteries are more susceptible to develop BCG-induced aneurysm or pseudo-aneurysm while only few cases of limb vessels pseudoaneurysm have been reported. We describe the case of a 76 -years-old man with a right common femoral artery pseudoaneurysm, possibly related to Bacillus Calmette-Guerin infection who was surgically repaired with a femoro-femoral pericardial bovine graft at our Institution. Despite the negative culture results, molecular assays detected M. Tubercolosis complex, raising suspicion that BCG therapy could have played a role even six years after instillations. This case underlines how, although rare, BCG infection should be considered among the possible causes of vascular complications in patients undergoing instillations for bladder cancer and that a multidisciplinary team for integrated treatment strategies is pivotal to allow optimal outcomes.