Peripheral Vascular Stent Infection: Case Report and Review of Literature

Whitcher, Greg H.; Bertges, Daniel J.; Shukla, Mrinal

doi:10.1016/j.avsg.2018.02.047

Cited by 14 publications

(16 citation statements)

References 36 publications

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“…[8][9][10][11] Imaging might show pseudoaneurysm formation, 1,3,9,10,12-18 abscess 3,11,15,17,19 and infiltration of the surrounding tissues, 8,20 but the inflammatory process might also lead to stent thrombosis, progressive arterial lysis, septic embolization and haemorrhage. 3,14,20,21 Initial CTA might also not show any evidence of an infection; 3 therefore, PET scan represents a useful exam in such situation. 2 In patients with a clinical suspicion of peripheral vascular graft/endograft infection, PET is recommended as an additional imaging modality to improve diagnostic accuracy (Class Level References I B) 22 because it has shown to have a superior sensitivity (93% vs 56%) and specificity (70% vs 57%) when compared with CTA 2 : it may differentiate between peri-prosthetic collection and involvement of the graft.…”

Section: Discussionmentioning

confidence: 99%

“…Imaging might show pseudoaneurysm formation, 1,3,9,10,12–18 abscess 3,11,15,17,19 and infiltration of the surrounding tissues, 8,20 but the inflammatory process might also lead to stent thrombosis, progressive arterial lysis, septic embolization and haemorrhage. 3,14,20,21…”

Section: Discussionmentioning

confidence: 99%

“…Treatment consisted in antibiotics alone in two patients (8.3%), but only one of them survived. Antibiotics and 13 Case report EIA BMS 22 months 1997 Kolvenbach et al 14 Case report CIA Stent graft 7 months 2001 Dosluoglu et al 25 Case report and literature review CIA and EIA BMS 7 months 2003 Walton et al 15 Case report SFA BMS Many months 2003 Macheda et al 26 Case report POP BMS 22 months 2006 Ting and Cheng 16 Case report SFA BMS 36 months 2006 Liapis et al 10 Case report EIA BMS 2 months 2007 Hogg et al 3 Case report and literature review CIA and EIA BMS 4 months 2007 Kondo et al 9 Case report EIA BMS 4 months 2009 Chisci et al 27 Case report SFA BMS 2 months SFA BMS 27 months 2011 Schneider et al 21 Case report SFA Stent graft 6.5 months 2011 Mlynskia et al 27 Case report CIA and EIA BMS 12 months 2012 Tanaka et al 1 Case report EIA BMS 36 months 2012 Houthoofd et al 17 Case report POP Stent graft 24 months 2015 Walker et al 19 Case report POP Stent graft 12 months 2015 Pecoraro et al 29 Case report SFA Stent graft 13 months 2016 Wissanji et al 8 Case report CIA bilateral Stent graft 120 months 2017 Walker 11 Case report POP Stent graft 48 months 2018 Krol et al 23 Case report and literature review SFA BMS 3 months 2018 TejuraN et al 18 Case report and literature review CIA BMS 24 months 2019 Whitcher et al 20 Case 12 Prolonged use or reuse catheter and puncture site haematoma Bunt et al 13 Bacteraemia due to fresh surgical wound from secondary intervention…”

Section: Treatment Outcomes and Complicationsmentioning

confidence: 99%

“…Coincident bacteraemia Earlier operation in stented area Schneider et al 21 None reported None reported Mlynskia et al 28 DM type II and coincident bacteraemia Tanaka et al 1 Diabetes type II No preoperative antibiotics Houthoofd et al 17 Infected skin lesions Walker et al 19 None reported None reported Pecoraro et al 29 None reported None reported Wissanji et al 8 None reported None reported Walker 11 None reported None reported Krol et al 23 Infected groin seroma Reiterated stenting procedures TejuraN et al 18 Diabetes type II Prolonged use of indwelling catheter Whitcher et al 20 Diabetes type II Reiterated stenting procedures Indexed case Repeated punctures urgent or emergent surgical explant were needed in 21 (87.5%) cases.…”

Section: Earlier Operation In Stented Areamentioning

confidence: 99%

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Late onset infection of covered and bare metal arterial stents

et al. 2021

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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.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Treatment Outcomes and Complicationsmentioning

confidence: 99%

Section: Earlier Operation In Stented Areamentioning

confidence: 99%

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Late onset infection of covered and bare metal arterial stents

et al. 2021

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“…These bacteria from the hospital environment and human skin are the most frequently found in stent infections: Staphylococcus spp. [6,7,8], Streptococcus spp. [9], Pseudomonas spp.…”

Section: Introductionmentioning

confidence: 99%

Antimicrobial and Antibiofilm Effects of Peptides from Venom of Social Wasp and Scorpion on Multidrug-Resistant Acinetobacter baumannii

Neves

Mortari

Schwartz

et al. 2019

Toxins

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Intravascular stent infection is a rare complication with a high morbidity and high mortality; bacteria from the hospital environment form biofilms and are often multidrug-resistant (MDR). Antimicrobial peptides (AMPs) have been considered as alternatives to bacterial infection treatment. We analyzed the formation of the bacterial biofilm on the vascular stents and also tested the inhibition of this biofilm by AMPs to be used as treatment or coating. Antimicrobial activity and antibiofilm were tested with wasp (Agelaia-MPI, Polybia-MPII, Polydim-I) and scorpion (Con10 and NDBP5.8) AMPs against Acinetobacter baumannii clinical strains. A. baumannii formed a biofilm on the vascular stent. Agelaia-MPI and Polybia-MPII inhibited biofilm formation with bacterial cell wall degradation. Coating biofilms with polyethylene glycol (PEG 400) and Agelaia-MPI reduced 90% of A. baumannii adhesion on stents. The wasp AMPs Agelaia-MPI and Polybia-MPII had better action against MDR A. baumannii adherence and biofilm formation on vascular stents, preventing its formation and treating mature biofilm when compared to the other tested peptides.

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