1
|
Ayyad M, Ayasa LA, Shbaita S, Qozat A, Tessarek J. Nonspecific Presentation of an Infected Aorto-Iliac Artery Stent Following Endovascular Revision and Stent Insertion. Vasc Endovascular Surg 2024; 58:436-442. [PMID: 37975794 PMCID: PMC10996291 DOI: 10.1177/15385744231217366] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2023]
Abstract
Over the last few decades, the use of covered stent grafts became increasingly popular; as it plays a pivotal role in the management of various atherosclerotic diseases that are rising in both incidence and prevalence. Subsequently, vascular stent infections, although rare, are becoming a well-recognized complication with possibly devastating consequences, owing to the difficulties associated with its diagnosis and treatment. This has prompted significant interest in the condition regarding its pathophysiology, modifiable and non-modifiable risk factors, diagnostic and therapeutic approaches, and the possible implementation of prophylactic measures. We herein present a case of a patient with an infected aortoiliac stent 4 weeks after endovascular revision with atherectomy and additional stent insertion. The patient initially developed nonspecific symptoms and later developed a life-threatening hemorrhage, which was urgently controlled using a percutaneously inserted covered stent at the infected site. Definitive treatment using extraanatomical bypass implantation and an explantation of the infected stents was performed with excellent clinical response.
Collapse
Affiliation(s)
- Mohammed Ayyad
- Faculty of Medicine, Al Quds University, Jerusalem, Palestine
| | - Laith A. Ayasa
- Faculty of Medicine, Al Quds University, Jerusalem, Palestine
| | - Sara Shbaita
- Faculty of Medicine, An Najah National University Nablus, Palestine
| | - Ahmad Qozat
- Vascular Surgery Department, Bonifatius Hospital, Lingen, Germany
| | - Jörg Tessarek
- Vascular Surgery Department, Bonifatius Hospital, Lingen, Germany
| |
Collapse
|
2
|
Voruganti N, Olowofela A, Wood JC, Mansukhani NA, Lewis BD, Brown KR. Superficial femoral artery stent extrusion. J Vasc Surg Cases Innov Tech 2021; 7:794-797. [PMID: 34877440 PMCID: PMC8627900 DOI: 10.1016/j.jvscit.2021.08.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2021] [Accepted: 08/13/2021] [Indexed: 11/21/2022] Open
Abstract
The superficial femoral artery is a common location for endovascular treatment of occlusive arterial disease. Stent extrusion is an uncommon complication of stent placement. In the present case report, we sought to raise awareness of this rare complication and have described the management of a single unique case. Although rare, the complication of stent extrusion should be considered in patients with abnormal symptoms after endovascular treatment of superficial femoral artery disease.
Collapse
|
3
|
Borghese O, Pisani A, Funaru DA, Di Marzo L, Di Centa I. Late onset infection of covered and bare metal arterial stents. Vascular 2021; 30:960-968. [PMID: 34348520 DOI: 10.1177/17085381211036548] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE The objective was to present the case of a late covered iliac stent late infection and report a comprehensive literature review on diagnosis and outcomes in this setting. METHODS A comprehensive review of the literature was performed through MedLine by two independent reviewers from 1990 to 2020 on reported cases of arterial stent late onset infection over arterial stents. The data about on the risk factors, clinical presentation, treatment and outcomes were collected. RESULTS Twenty-two studies were selected as pertinent for the analysis, totalling 24 patients including the indexed case. Infection occurred at a median of 22 months postoperatively (range 2-120 months) over a bare metal stent in 66.7% (n 16) of cases versus 33.3% (n 8) over a covered stent. Clinical presentation included local symptoms (local pain, oedema, petechiae or skin rash) in 21 (87.5%) cases and non-specific systemic symptoms (fever, sepsis, chills and leucocytosis) in 8 cases (33.3%). In 4 cases (16.7%), patients presented with haemorrhagic shock upon arterial rupture. The bacteria most frequently encountered were S. aureus (54.2% of cases). Several factors were supposed to be responsible for the infection including among which procedure-related (non-aseptic technique, lack of prophylactic antibiotics and repetitive punctures at the access site) or related to pre-existing patient's clinical conditions (immunosuppression, diabetes and concurrent infection) have been considered responsible for the infection. Treatment consisted in antibiotics alone (2 patients, 8.3%) or in association with surgical explant, both with or and without revascularization (n 21, 87.5%). In one case, an endovascular coiling was performed. Complications occurred in 29.2% (n 7) of cases and included the need for amputation, bowel resection, endocarditis, pulmonary failure or pneumonia. Overall, three patients (12.5%) died from a septic shock or multi-organ failure. CONCLUSIONS Intravascular stent infection is a rare but fearsome condition associated with high morbidity and mortality.
Collapse
Affiliation(s)
- Ottavia Borghese
- Department of Vascular and Endovascular Surgery, Foch Hospital, Suresnes, France.,Sapienza University, Rome, Italy
| | - Angelo Pisani
- Departement of Cardiac Surgery, 55183Pineta Grande Hospital, Castel Volturno, Italy
| | - Dan Andrei Funaru
- Department of Vascular and Endovascular Surgery, Foch Hospital, Suresnes, France
| | | | - Isabelle Di Centa
- Department of Vascular and Endovascular Surgery, Foch Hospital, Suresnes, France
| |
Collapse
|
4
|
Dinoto E, Ferlito F, Urso F, Mirabella D, Bajardi G, Pecoraro F. Iliac-femoral stent-graft infection after hybrid procedure redo: Case report. Int J Surg Case Rep 2021; 84:106096. [PMID: 34119935 PMCID: PMC8209074 DOI: 10.1016/j.ijscr.2021.106096] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Revised: 06/06/2021] [Accepted: 06/06/2021] [Indexed: 11/17/2022] Open
Abstract
Introduction Stent-graft infection in peripheral arteries is rare and potentially dangerous. The use of hybrid procedures, in complicated patients previously treated, involves an increase of infective risk especially in no collaborative patients. Presentation of case We report a case of rare stent-graft infection in a patient treated for a Rutherford IV Multiple Peripheral Arterial Disease (MPAD) involving the right iliac-femoral axis with stenosis on deep femoral artery due to a previously stenting procedure for Superficial Femoral artery (SFA) stenosis. The first simultaneous hybrid intervention consisted of an endovascular iliac stent-graft placement and a surgical common femoral patch angioplasty. After two months the patient was readmitted to our unit for a purulent secretion through a fistulous channel and a suspect infection of stent-graft. Subsequently, the stent-graft was completely removed without possibility to have a surgical revascularization. An amputation major amputation was needed for irreversible ischemia of right leg. Discussion The incidence of stent-graft infection after endovascular aortic aneurysm repair had been reported as 0.4–1.0% while Aortoiliac graft infection occurs in 2–6% of patients. Hybrid procedures are secure and need close follow-up for cases of redo and patient with comorbidities. Conclusions Graft infection is a rare complication after endovascular treatments. Hybrid procedures outcomes are good with less morbidity but in patient with high risk of infection is important a close follow-up. Stent-graft infection in peripheral arteries is rare and potentially dangerous. Stent-graft infection after angioplasty Aortoiliac occurs in 2–6% of patients. Hybrid procedures are useful, patients high risk for infection need a close followup.
Collapse
Affiliation(s)
- E Dinoto
- Vascular Surgery Unit, AOUP Policlinico 'P. Giaccone', Palermo, Italy.
| | - F Ferlito
- Vascular Surgery Unit, AOUP Policlinico 'P. Giaccone', Palermo, Italy
| | - F Urso
- Vascular Surgery Unit, AOUP Policlinico 'P. Giaccone', Palermo, Italy
| | - D Mirabella
- Vascular Surgery Unit, AOUP Policlinico 'P. Giaccone', Palermo, Italy
| | - G Bajardi
- Vascular Surgery Unit, AOUP Policlinico 'P. Giaccone', Palermo, Italy; Department of Surgical, Oncological and Oral Sciences, University of Palermo, Italy
| | - F Pecoraro
- Vascular Surgery Unit, AOUP Policlinico 'P. Giaccone', Palermo, Italy; Department of Surgical, Oncological and Oral Sciences, University of Palermo, Italy
| |
Collapse
|
5
|
Krol E, Ongstad S, Gensler TW, Panneton JM. Delayed Superficial Femoral Artery Covered Stent Infection: Report of Two Cases and Review of Literature. Ann Vasc Surg 2018; 52:312.e1-312.e5. [DOI: 10.1016/j.avsg.2018.04.023] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2018] [Revised: 04/11/2018] [Accepted: 04/23/2018] [Indexed: 10/28/2022]
|
6
|
Whitcher GH, Bertges DJ, Shukla M. Peripheral Vascular Stent Infection: Case Report and Review of Literature. Ann Vasc Surg 2018; 51:326.e9-326.e15. [DOI: 10.1016/j.avsg.2018.02.047] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2018] [Accepted: 02/12/2018] [Indexed: 12/12/2022]
|
7
|
Late Complication after Superficial Femoral Artery (SFA) Aneurysm: Stent-graft Expulsion Outside the Skin. Cardiovasc Intervent Radiol 2014; 38:1299-302. [DOI: 10.1007/s00270-014-0970-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2014] [Accepted: 07/15/2014] [Indexed: 11/26/2022]
|
8
|
Bosman WMPF, Borger van der Burg BLS, Schuttevaer HM, Thoma S, Hedeman Joosten PP. Infections of intravascular bare metal stents: a case report and review of literature. Eur J Vasc Endovasc Surg 2013; 47:87-99. [PMID: 24239103 DOI: 10.1016/j.ejvs.2013.10.006] [Citation(s) in RCA: 61] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2013] [Accepted: 10/06/2013] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The objective of the paper is to present a case of an infected bare metal stent in the left common iliac artery that was removed by an urgent operation, and to review the literature on diagnosis and outcome of infected coronary and non-coronary metal stents. METHODS A systematic search of the Medline database was performed with the purpose of identifying risk factors, signs and symptoms, imaging strategies, and treatment modalities of bare metal stent infections, both coronary and peripheral. RESULTS In total, 76 additional studies/case reports (48 non-coronary; 29 coronary) were included and analyzed. Intravascular bare metal stent infections are a rare but serious complication, often leading to emergency surgery (overall: 75.3%; non-coronary cases: 83.3%; coronary cases: 62.1%). In 25.0% of the non-coronary cases, infection led to amputation of an extremity or removal of viscera. Reported mortality was up to 32.5% of the cases (non-coronary: 22.9%; coronary 48.3%). Physicians should always be suspicious of a stent infection when patients present with aspecific symptoms such as fever and chills after stent placement. Additional imaging can be used to detect the presence of a pseudoaneurysm. A PET-CT is an ideal medium for identification of a stent infection. CONCLUSIONS Intravascular stent infection is associated with a high risk of morbidity and mortality. Surgery is the preferred treatment option, but not always possible, especially in patients with a coronary stent. In selected cases, bare metal stent infections may be prevented by the use of prophylactic antibiotics at stent placement.
Collapse
Affiliation(s)
- W M P F Bosman
- Department of Surgery, Rijnland Hospital Leiderdorp, The Netherlands.
| | | | - H M Schuttevaer
- Department of Radiology, Rijnland Hospital Leiderdorp, The Netherlands
| | - S Thoma
- Department of Radiology, Rijnland Hospital Leiderdorp, The Netherlands
| | | |
Collapse
|
9
|
Schneider J, Patel N, Hashemi F, Kim S, Verta M. Infected Viabahn Stent Graft in the Superficial Femoral Artery. Eur J Vasc Endovasc Surg 2011; 42:699-703. [DOI: 10.1016/j.ejvs.2011.08.005] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2011] [Accepted: 08/08/2011] [Indexed: 11/25/2022]
|
10
|
Hogg ME, Peterson BG, Pearce WH, Morasch MD, Kibbe MR. Bare metal stent infections: Case report and review of the literature. J Vasc Surg 2007; 46:813-20. [PMID: 17903662 DOI: 10.1016/j.jvs.2007.05.043] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2007] [Accepted: 05/21/2007] [Indexed: 10/22/2022]
Abstract
Infection of bare metal stents in the vasculature is rare, but associated with significant morbidity and mortality. We report two cases of bare metal stent infections and review the literature regarding infected bare metal stents with respect to risk factors, pathophysiology, diagnosis, treatment, and prevention. Overall, this article highlights the need to have a high index of suspicion of bare metal stent infection, since prompt diagnosis and treatment can ultimately decrease the morbidity and mortality associated with this devastating problem.
Collapse
Affiliation(s)
- Melissa E Hogg
- Division of Vascular Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, USA
| | | | | | | | | |
Collapse
|
11
|
Kakani N, Travis S, Hancock J. Recanalization of an Occluded Infrainguinal Vein Graft Complicated by Graft Aneurysm. Cardiovasc Intervent Radiol 2007; 30:1271-3. [PMID: 17671811 DOI: 10.1007/s00270-007-9106-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The technique of subintimal angioplasty has been described for the recanalisation of native vessels after occlusion of infrainguinal vascular bypass grafts. We report a case in which an attempt at such treatment resulted in inadvertent but successful recanalisation of the occluded vein graft instead. This was complicated by graft perforation and subsequent graft aneurysm which was successfully treated with a covered stent.
Collapse
Affiliation(s)
- Nirmal Kakani
- Department of Clinical Imaging, Royal Cornwall Hospital, Cornwall, UK
| | | | | |
Collapse
|
12
|
Tang GL, Morasch MD. Role of Stents, Drug-Eluting Stents, and Stent-Grafts in Treatment of Infrainguinal Arterial Disease. Semin Vasc Surg 2007; 20:37-41. [PMID: 17386362 DOI: 10.1053/j.semvascsurg.2007.02.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Infrainguinal peripheral arterial disease is increasingly treatable by endovascular techniques. Bare-metal, drug-eluting, and covered stents (stent-grafts) are increasingly important adjuncts to percutaneous transluminal angioplasty in the treatment of occlusive and aneurysmal disease. Preliminary data suggest bioabsorbable stents may also have a significant clinical impact as well. In this article, we describe the available evidence supporting use of stents in the femoropopliteal and tibial arteries, as well as some of their limitations and complications.
Collapse
Affiliation(s)
- Gale L Tang
- Division of Vascular Surgery, Department of Surgery, Feinberg School of Medicine, Northwestern University, Chicago, IL 60611, USA
| | | |
Collapse
|
13
|
Angiletta D, Impedovo G, Pestrichella F, Marotta V, Perilli F, Regina G. Blunt femoropopliteal trauma in a child: Is stenting a good option? J Vasc Surg 2006; 44:201-4; discussion 205. [PMID: 16828446 DOI: 10.1016/j.jvs.2006.02.039] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2005] [Accepted: 02/04/2006] [Indexed: 11/22/2022]
Abstract
Vascular injuries resulting from blunt trauma are uncommon in the pediatric age. In children, there are particular factors that should be taken into account when vascular traumatic lesions are treated: small vessel size or vessel spasm, a higher risk of infection, a tendency for restenosis, and rapid body growth. The endovascular procedure is a minimally invasive, quick technique that restores blood flow immediately. The stent's fate is the Achille's heel of this technique; this is the reason why a careful follow-up and further studies are required.
Collapse
|
14
|
Abstract
Every interventional procedure can result in infective complications. Generally the incidence is low; however, with newer and more aggressive techniques the infection risk is more prevalent and can result in serious adverse outcomes to our patients. Antibiotic prophylaxis has become commonplace; however, there is little controlled data to underpin our regimens and most choices are based on surgical practice and anecdotal evidence. The rise of antibiotic resistance and treatment of many immunocompromised patients further compounds the difficulties faced. The purpose of this article was to examine the evidence that is presented regarding antibiotic prophylaxis in interventional radiology and highlight how we integrate this into our daily practice. In particular we will focus on evolving procedures and techniques that are associated with a high incidence of infection.
Collapse
Affiliation(s)
- P Beddy
- Department of Interventional Radiology, St. James Hospital, Dublin, Ireland
| | | |
Collapse
|