title: Septic embolization arising from infected pseudoaneurysms following percutaneous transluminal coronary angioplasty: a report of 2 cases and review of the literature.
abstract: Septic embolization arising from infected pseudoaneurysms following percutaneous transluminal coronary angioplasty (PTCA) constitutes a distinct clinical and histopathologic entity. Pseudoaneurysms are a potential complication of both cardiac catheterization and PTCA. Repeated or prolonged catheterization increases the risk of bacterial seeding of these sites, resulting in septic embolization. Characteristic clinical features include fever within 2 to 5 days, unilateral embolic disease, and Staphylococcus aureus septicemia. Culture and examination of biopsy specimens of the embolic lesions typically demonstrate gram-positive microorganisms. We describe 2 patients presenting with ipsilateral palpable purpura, petechiae, and livedo reticularis caused by septic emboli from infected pseudoaneurysms. The recommended treatment includes administration of appropriate systemic antibiotics and surgical resection of the infected pseudoaneurysm. Both cholesterol and septic emboli should be considered in the differential diagnosis of ipsilateral embolic disease induced by invasive vascular procedures.
authors.affiliation: John A. Burns School of Medicine, University of Hawaii, 1380 Lusitana St, Suite 412, Honolulu, HI 96813, USA.
authors.forename: A K
authors.initials: AK
authors.lastname: Izumi
authors.forename: C P
authors.initials: CP
authors.lastname: Samlaska
authors.forename: D W
authors.initials: DW
authors.lastname: Hew
authors.forename: P P
authors.initials: PP
authors.lastname: Bruno
mesh_terms: D000328:Adult; D017541:Aneurysm, False / Q000209:etiology* / Q000382:microbiology / Q000601:surgery; D015906:Angioplasty, Balloon, Coronary / Q000009:adverse effects*; D003937:Diagnosis, Differential; D004617:Embolism / Q000209:etiology* / Q000473:pathology; D006095:Gram-Positive Cocci / Q000302:isolation & purification; D006801:Humans; D007083:Iliac Artery / Q000382:microbiology / Q000473:pathology / Q000601:surgery; D008297:Male; D008875:Middle Aged; D018805:Sepsis / Q000209:etiology* / Q000473:pathology; D013207:Staphylococcal Skin Infections / Q000175:diagnosis / Q000209:etiology*; D013211:Staphylococcus aureus / Q000302:isolation & purification