Late onset infection of covered and bare metal arterial stents

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.

Open Surgical Conversion of Popliteal Endograft Infection: Case Reports And Literature Review

“…Also, blood tests could be a simple and clear but not specific systemic infective monitoring index. The most common organisms implicated in vascular graft infections are gram-positive and gram-negative bacteria such as Staphylococcus and Pseudomonas [5,8] and it is supported also by our review of the literature indicating the same incidence of popliteal infection and the general vascular one. Microorganism identification is a fundamental step for the management of the disease because through the right antibiotic choice, the main attack route can be identified, and it could influence all patients' outcomes.…”

“…We identified two pertinent articles. Firstly, we added a 2022 case report [7]; then the second case report was indirectly found in a 2022 review of the literature about late-onset infection of covered and bare metal arterial stents [8]. Even if it was a 2003 article [14] laying outside the second timeline, it described a case report more pertinent to our research so we decided to consider it as a relative inclusion error of the first section, adding it to the second section.…”

“…To finalize our research, we decided to divide our review into two timeline sections: the first was based on all popliteal stent graft infection articles published from 1980 to 2018 including the previous Annals of Vascular Surgery 2018 review [6] (Figure 4), and the second one included articles from 2018 to 2024 (Figure 5). In the second section, we directly identified one case report article [7] from free PubMed research; then the last case report article was indirectly found from a 2022 review of the literature's general stent-graft infection [8].…”