Femoral artery infection associated with a percutaneous arterial suture device

Abstract

This is a case report of a femoral artery infection with fatal outcome after using a percutaneous suture mediated closure device: A 77-year old patient underwent diagnostic angiography of his thoracic and abdominal aortic aneurysm, the puncture site was closed with the Perclose system. He developed a staphylococcal femoral artery infection with groin abscess, requiring surgical intervention with debridement and removal of the Perclose suture. After stent graft exclusion of the thoracic and abdominal aortic aneurysm a staphylococcal sepsis occurred and the patient died of aneurysm rupture months later despite long term antibiotic therapy. Since the use of the Perclose device carries an increased risk of femoral artery infection with septic endarteritis and bacteremia, it should not be used in routine diagnostic angiography.

Safety and efficacy of staple‐mediated femoral arteriotomy closure: Results from a randomized multicenter study

“…Similarly, clinical evaluation of suture based closure devices such as the Perclose® confirm clinical efficacy [43]. However, there is a small but clinically significant increase in the incidence of femoral endarteritis, infection, and vascular occlusion with its use [44–48]. In this study, the EVS safely provided effective femoral arterial closure following sheath removal compared to the standard of manual compression.…”

Methicillin-sensitiveStaphylococcusaureusbacterial endarteritis associated with vascular closure device

“…Percutaneous endovascular procedures, for diagnosis or intervention, are increasingly common in clinical practice, and femoral route is the preferred route in most interventions 1. The standard treatment to ensure haemostasis after arterial puncture, is direct or mechanical manual compression, followed by bed rest for several hours 2. Percutaneous closure devices (PCD) achieve safe and immediate haemostasis, reducing the length and costs of hospitalisation, increase haemodynamic laboratory's productivity and increase patients comfort 1–3.…”

“…The standard treatment to ensure haemostasis after arterial puncture, is direct or mechanical manual compression, followed by bed rest for several hours 2. Percutaneous closure devices (PCD) achieve safe and immediate haemostasis, reducing the length and costs of hospitalisation, increase haemodynamic laboratory's productivity and increase patients comfort 1–3. Complications associated with PCD are rare, but should be readily recognised to reduce morbidity and mortality.…”

“…The spectrum of infectious complications comprises isolated soft tissue infection and infectious endarteritis, which may be complicated by peripheral embolisation and septic shock 1. The overall infectious complications associated to PCD rate is 0.3% 2. Infective endarteritis is an extremely rare complication.…”

“…Isolation of Staphylococcal species in virtually all cases described in the literature supports this theory. Additional factors include errors in regarding sterility during interventional procedures and post-puncture hematoma, which provide an ideal culture medium 2…”