title: Distal septic emboli and fatal brachiocephalic artery mycotic pseudoaneurysm as a complication of stenting.
abstract: The use of percutaneous angioplasty with subsequent intravascular metallic stent placement has gained increasing acceptance over the past decade. Infections of these stents appear to be uncommon; however, the rarity of this complication may in part be the result of a lack of availability of long-term follow-up data. A number of examples of infected cardiac and peripheral vascular stents have been reported, often with fatal consequences. Herein, we report a 74-year-old woman who underwent subclavian and brachiocephalic artery angioplasty and stent placement for symptomatic stenoses. Six months after the initial intervention, the patient returned with restenosis of the stents and underwent repeat angioplasty to restore full patency. Two weeks later, the patient was readmitted with generalized malaise and multiple erythematous, macular lesions on the right forearm and hand. Blood cultures grew Staphylococcus aureus, and a computed tomographic scan of the chest showed a large brachiocephalic artery pseudoaneurysm with surrounding hematoma. Despite prompt surgical intervention, this complication proved ultimately fatal. Infections of metallic endovascular stents are potentially life-threatening complications and must be addressed urgently, including possible surgical intervention.
authors.affiliation: Division of Vascular Surgery, Joseph B. Whitehead Department of Surgery, Emory University School of Medicine and the Emory University Hospital, Atlanta, GA 30322, USA.
authors.forename: Anita
authors.initials: A
authors.lastname: Pruitt
authors.forename: Thomas F
authors.initials: TF
authors.lastname: Dodson
authors.forename: Sasan
authors.initials: S
authors.lastname: Najibi
authors.forename: Vinod
authors.initials: V
authors.lastname: Thourani
authors.forename: Andrew
authors.initials: A
authors.lastname: Sherman
authors.forename: Harry
authors.initials: H
authors.lastname: Cloft
authors.forename: Angela
authors.initials: A
authors.lastname: Caliendo
authors.forename: Robert B
authors.initials: RB
authors.lastname: Smith
mesh_terms: D000368:Aged; D017541:Aneurysm, False / Q000000981:diagnostic imaging / Q000209:etiology*; D000785:Aneurysm, Infected / Q000000981:diagnostic imaging / Q000209:etiology*; D017130:Angioplasty / Q000009:adverse effects; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects*; D016122:Brachiocephalic Trunk / Q000000981:diagnostic imaging / Q000382:microbiology*; D004617:Embolism / Q000000981:diagnostic imaging / Q000209:etiology*; D017809:Fatal Outcome; D005260:Female; D006801:Humans; D016459:Prosthesis-Related Infections / Q000150:complications* / Q000000981:diagnostic imaging; D011859:Radiography; D018805:Sepsis / Q000000981:diagnostic imaging / Q000209:etiology*; D015607:Stents / Q000009:adverse effects*