Objective: Acute limb ischemia (ALI) due to thromboembolism is a limb-and life-threatening condition regularly encountered by vascular surgeons. Iatrogenic distal embolization is occasionally seen as a complication of various endovascular procedures. We present a series of four patients who developed ALI due to arterial embolization during cardiovascular procedures that were successfully treated via catheter directed aspiration embolectomy. Methods: Retrospective review of demographics, risk factors, and procedural outcomes was completed for 4 patients who presented with ALI due to distal embolization following cardiovascular procedures. All patients were successfully treated with catheter directed aspiration embolectomy using the Penumbra Indigo System (Penumbra Inc., Alameda, California). All patients had high-quality angiography demonstrating successful embolectomy and end-procedure patency. Results: Three patients presented with Rutherford 2A and one with Rutherford 2B ALI secondary to intraoperative distal embolization. Three patients presented with ALI secondary to distal embolization during peripheral vascular interventions, and one following emergent intra-aortic balloon pump (IABP) placement for myocardial infarction. All emboli were located in the infra-inguinal vasculature. Median post-operative ABIs were 0.94 (n = 4). Median length of stay was 2 days. There were no mortalities and no need for adjunctive fasciotomy, amputation, or bypass for limb salvage. All patients improved clinically after intervention, and returned to their reported pre-hospitalization functional status. Conclusion: All procedures achieved technical success with catheter-directed aspiration thrombectomy with or without adjunctive lysis. Catheter-directed aspiration embolectomy with the Penumbra Indigo System for ALI following an iatrogenic embolic event is a safe, less-invasive treatment option. The use of this technology may reduce the need for traditional open thrombectomy or thrombolytic therapy to address ALI.
Results:The patient represented two weeks later with right lower extremity edema, erythema, surgical incisions drainage and fever to 103 F. Blood, wound and urine cultures were obtained in the emergency department before initiating vancomycin and piperacillin/tazobactam. Twenty-four hours later his blood cultures grew gram-negative rods in clusters and later suspected to be M catarrhalis. The patient was taken to the operating room for graft excision. Intraoperatively purulence was encountered at the distal anastomosis and tracked proximally to the groin wound. Fluid sent for culture did not yield growth of any species. piperacillin/tazobactam was continued and vancomycin was stopped. This therapy was changed within 48 out hours later to ceftriaxone owing to acute kidney injury. Owing to ongoing ischemic rest pain he underwent right below-the-knee amputation 3 days later.Conclusions: Our case illustrates as a rare potential cause of prosthetic lower extremity bypass graft infection. To date this is the first report of M catarrhalis in this vascular surgery setting.
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