Distal septic emboli and fatal brachiocephalic artery mycotic pseudoaneurysm as a complication of stenting

Abstract

The use of percutaneous angioplasty with subsequent intravascular metallic stent placement has gained increasing acceptance over the past decade. Infections of these stents appear to be uncommon; however, the rarity of this complication may in part be the result of a lack of availability of long-term follow-up data. A number of examples of infected cardiac and peripheral vascular stents have been reported, often with fatal consequences. Herein, we report a 74-year-old woman who underwent subclavian and brachiocephalic artery angioplasty and stent placement for symptomatic stenoses. Six months after the initial intervention, the patient returned with restenosis of the stents and underwent repeat angioplasty to restore full patency. Two weeks later, the patient was readmitted with generalized malaise and multiple erythematous, macular lesions on the right forearm and hand. Blood cultures grew Staphylococcus aureus, and a computed tomographic scan of the chest showed a large brachiocephalic artery pseudoaneurysm with surrounding hematoma. Despite prompt surgical intervention, this complication proved ultimately fatal. Infections of metallic endovascular stents are potentially life-threatening complications and must be addressed urgently, including possible surgical intervention.

The Primary Patency of Percutaneous Transluminal Angioplasty in Hemodialysis Patients With Vascular Access Failure

“…They reported primary patency rates of 56% and 28% at 1 and 2 years, respectively. Disadvantages of stent placement include potential collateral vein obstruction, shortening and migration of the stent, infection, and the loss of outflow in the extremity if the stent should fail 23)24)…”

Intra-arterial device infections

“…Cases were excluded if they were endovascular stent infections of the coronary or intracerebral arteries, endovascular stent infections associated with aortoenteric fistulas (because these could be secondary to a mechanical disruption of the stent rather than a primary infection), cases with only bacteremia or fungemia after stent placement as the only diagnostic criterion, or secondarily infected stents (stents placed in the setting of mycotic aneurysms). Thirty-two cases met diagnostic criteria for PEVSI [32][33][34][35][36][37][38][39][40][41][42]. Findings are summarized in Table 2.…”

Current Management of Vascular Infections

“…Periprocedural bacteremia from remote sites of infection or during secondary endovascular interventions is considered to be the cause of stent-graft contamination. [77] Perigraft inflammation or fluid is the main CT findings with diagnostic sensitivity of 85%. Treatment consists of antibiotics and graft excision followed by extra-anatomic bypass or in situ autogenous replacement.…”