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An Infected, Noncoronary, Bare Metal Stent Presenting as a Right Groin Abscess. Case Rep Vasc Med 2023. [DOI: 10.1155/2023/6777086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/09/2023] Open
Abstract
Bare metal stent infections complicating peripheral endovascular stenting are rare but can be associated with devastating morbidities. The current standard of care necessitates explantation and extra-anatomical bypass of the affected limb. We report the case of a patient presenting with a right groin abscess with draining sinuses secondary to an infected common femoral and right external iliac artery bare metal stent. In addition, a portion of the stent was explanted into the subcutaneous tissues instead of where it was placed intravascularly one year prior. The patient was not an ideal candidate for explantation and bypass due to significant medical comorbidities and underwent local debridement and long-term antibiotic management instead. His postoperative course was uncomplicated, and he had a successful outcome with management utilizing antibiotics and debridement. We aim to highlight the importance of recognizing bare metal stent infections along with their deceptive cutaneous manifestations in order to prevent the development of significant morbidity and mortality.
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Cao H, Qiao S, Qin H, Jandt KD. Antibacterial Designs for Implantable Medical Devices: Evolutions and Challenges. J Funct Biomater 2022; 13:jfb13030086. [PMID: 35893454 PMCID: PMC9326756 DOI: 10.3390/jfb13030086] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2022] [Revised: 06/12/2022] [Accepted: 06/17/2022] [Indexed: 11/25/2022] Open
Abstract
The uses of implantable medical devices are safer and more common since sterilization methods and techniques were established a century ago; however, device-associated infections (DAIs) are still frequent and becoming a leading complication as the number of medical device implantations keeps increasing. This urges the world to develop instructive prevention and treatment strategies for DAIs, boosting the studies on the design of antibacterial surfaces. Every year, studies associated with DAIs yield thousands of publications, which here are categorized into four groups, i.e., antibacterial surfaces with long-term efficacy, cell-selective capability, tailored responsiveness, and immune-instructive actions. These innovations are promising in advancing the solution to DAIs; whereas most of these are normally quite preliminary “proof of concept” studies lacking exact clinical scopes. To help identify the flaws of our current antibacterial designs, clinical features of DAIs are highlighted. These include unpredictable onset, site-specific incidence, and possibly involving multiple and resistant pathogenic strains. The key point we delivered is antibacterial designs should meet the specific requirements of the primary functions defined by the “intended use” of an implantable medical device. This review intends to help comprehend the complex relationship between the device, pathogens, and the host, and figure out future directions for improving the quality of antibacterial designs and promoting clinical translations.
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Affiliation(s)
- Huiliang Cao
- Interfacial Electrochemistry and Biomaterials, School of Materials Science and Engineering, East China University of Science and Technology, Shanghai 200237, China
- Lab of Low-Dimensional Materials Chemistry, Key Laboratory for Ultrafine Materials of Ministry of Education, East China University of Science & Technology, Shanghai 200237, China
- Chair of Materials Science, Otto Schott Institute of Materials Research (OSIM), Friedrich Schiller University Jena, 07743 Jena, Germany
- Correspondence: (H.C.); (S.Q.); (H.Q.); (K.D.J.)
| | - Shichong Qiao
- Department of Implant Dentistry, Shanghai Ninth People’s Hospital, College of Stomatology, Shanghai Jiao Tong University School of Medicine, Shanghai 200011, China
- National Clinical Research Center for Oral Diseases, Shanghai 200011, China
- Shanghai Key Laboratory of Stomatology & Shanghai Research Institute of Stomatology, Shanghai 200011, China
- Correspondence: (H.C.); (S.Q.); (H.Q.); (K.D.J.)
| | - Hui Qin
- Department of Orthopaedics, Shanghai Jiaotong University Affiliated Sixth People’s Hospital, Shanghai 200233, China
- Correspondence: (H.C.); (S.Q.); (H.Q.); (K.D.J.)
| | - Klaus D. Jandt
- Chair of Materials Science, Otto Schott Institute of Materials Research (OSIM), Friedrich Schiller University Jena, 07743 Jena, Germany
- Jena Center for Soft Matter (JCSM), Friedrich Schiller University Jena, 07743 Jena, Germany
- Jena School for Microbial Communication (JSMC), Neugasse 23, 07743 Jena, Germany
- Correspondence: (H.C.); (S.Q.); (H.Q.); (K.D.J.)
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Schmidt EKE, Bhutia S. Unusual source of fever: the curious case of an infected arterial stent graft presenting as a ruptured popliteal artery aneurysm. BMJ Case Rep 2021; 14:14/2/e239272. [PMID: 33622748 PMCID: PMC7903086 DOI: 10.1136/bcr-2020-239272] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
A 71-year-old man presented to the emergency department with a 1-week history of lethargy, general malaise and intermittent high fever. He had presented 18 months ago, and again 12 months earlier with similar symptoms. On this third presentation, the fever was accompanied by right thigh swelling and pain. The patient was referred to the vascular surgeons with concern regarding an infected vascular stent graft from previous treatment of popliteal artery aneurysms (PAA) 8 years earlier. CT angiogram demonstrated a collapsed right PAA sac with a large collection, consistent with ruptured PAA, and a single gas bubble around the indwelling stent graft. The patient recovered well after a course of antibiotics and surgical explantation of the graft. Infection is a potential complication of any implanted arterial advice, and needs to be considered even years after initial intervention and with no localising symptoms.
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Affiliation(s)
| | - Sherab Bhutia
- Vascular Surgery, Cairns Hospital, Cairns, Queensland, Australia
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Titomihelakis G, Feghali A, Nguyen T, Salvatore D, DiMuzio P, Abai B. Endovascular management and the risk of late failure in the treatment of ureteroarterial fistulas. JOURNAL OF VASCULAR SURGERY CASES INNOVATIONS AND TECHNIQUES 2019; 5:396-401. [PMID: 31660458 PMCID: PMC6806659 DOI: 10.1016/j.jvscit.2019.06.010] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/12/2019] [Accepted: 06/30/2019] [Indexed: 12/17/2022]
Abstract
Ureteroarterial fistula (UAF) is a rare and life-threatening source of hematuria. A high index of suspicion is warranted for early diagnosis and timely intervention. Because of high perioperative risk and comorbidities in UAF patients, the endovascular approach has become preferred for repair. Infection can complicate this mode of therapy, and treatment with antibiotics is important. Herein we present five cases of secondary UAFs treated with stent graft alone or stent graft and embolization.
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Affiliation(s)
- George Titomihelakis
- Division of Vascular Surgery, Thomas Jefferson University Hospital, Philadelphia, Pa
| | - Anthony Feghali
- Division of Vascular Surgery, Thomas Jefferson University Hospital, Philadelphia, Pa
| | - Tuong Nguyen
- Division of Vascular Surgery, Thomas Jefferson University Hospital, Philadelphia, Pa
| | - Dawn Salvatore
- Division of Vascular Surgery, Thomas Jefferson University Hospital, Philadelphia, Pa
| | - Paul DiMuzio
- Division of Vascular Surgery, Thomas Jefferson University Hospital, Philadelphia, Pa
| | - Babak Abai
- Division of Vascular Surgery, Thomas Jefferson University Hospital, Philadelphia, Pa
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