Bilateral renal artery stent infection and pseudoaneurysm formation

Infections of intravascular bare metal stents: a case report and review of literature

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.

Bare metal stent infections: Case report and review of the literature

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.

Role of Stents, Drug-Eluting Stents, and Stent-Grafts in Treatment of Infrainguinal Arterial Disease

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.

Intra-arterial device infections

As an increasing number and variety of prosthetic devices are used in cardiovascular medicine, novel infectious complications have been described. Infection of intra-arterial devices, including arterial closure devices, prosthetic carotid patches, coronary artery stents and endovascular stents, and stent-grafts, is now being reported. Prosthetic vascular graft infection is an older, more common, and better-characterized entity, but recent developments in the surgical management of these infections have prompted a re-examination of the syndrome. Staphylococcal species account for most intra-arterial device infections, and often, morbidity and mortality rates are high. An update on intra-arterial device infections is warranted.

Aneurysmal Degeneration of the Superficial Femoral Artery following Stenting: An Uncommon Infectious Complication

Infrainguinal angioplasty and stenting is becoming a more commonly performed procedure. Its durability remains a matter of debate, however. Aneurysmal degeneration following angioplasty and stenting is a complication not previously described in the literature with regard to the superficial femoral artery. We present a case in which two aneurysms of the superficial femoral artery developed following angioplasty and multiple-stent placements in a patient who had previously undergone a failed femoral-to-below-the-knee popliteal artery PTFE bypass graft. The patient presented to our institution with an occluded, infected bypass graft. He was treated with graft and femoral artery/stent excision and vein bypass grafting. A brief review of infectious complications after stent placement is included.

Infected endovascular stents managed with medical therapy alone

More than 400,000 endovascular stents are put in place in the United States annually. Infectious complications have been reported in fewer than one in 10,000 cases. It remains unclear whether the optimal management strategy for these patients is with medicine alone or surgery. We report two cases of endovascular stent infections that were treated successfully with antibiotics alone.