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.
Department of Surgery, Rijnland Hospital Leiderdorp, The Netherlands. Electronic address: w.bosman@rijnland.nl.
W M P F
WM
Bosman
Department of Surgery, Rijnland Hospital Leiderdorp, The Netherlands.
B L S
BL
Borger van der Burg
Department of Radiology, Rijnland Hospital Leiderdorp, The Netherlands.
H M
HM
Schuttevaer
Department of Radiology, Rijnland Hospital Leiderdorp, The Netherlands.
S
S
Thoma
Department of Surgery, Rijnland Hospital Leiderdorp, The Netherlands.
P Ph
PP
Hedeman Joosten
D017541:Aneurysm, False / Q000175:diagnosis / Q000209:etiology* / Q000382:microbiology / Q000628:therapy; D000785:Aneurysm, Infected / Q000175:diagnosis / Q000209:etiology* / Q000382:microbiology / Q000628:therapy; D001157:Arterial Occlusive Diseases / Q000000981:diagnostic imaging / Q000628:therapy*; D003251:Constriction, Pathologic; D057510:Endovascular Procedures / Q000009:adverse effects* / Q000295:instrumentation; D005260:Female; D006801:Humans; D007083:Iliac Artery / Q000000981:diagnostic imaging; D008875:Middle Aged; D011150:Popliteal Artery / Q000000981:diagnostic imaging; D049268:Positron-Emission Tomography; D011237:Predictive Value of Tests; D016459:Prosthesis-Related Infections / Q000175:diagnosis / Q000209:etiology* / Q000382:microbiology / Q000628:therapy; D012307:Risk Factors; D013203:Staphylococcal Infections / Q000175:diagnosis / Q000209:etiology* / Q000382:microbiology / Q000628:therapy; D015607:Stents / Q000009:adverse effects*; D013923:Thromboembolism / Q000000981:diagnostic imaging / Q000628:therapy*; D015912:Thrombolytic Therapy; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
Endovascular procedures; False aneurysm; Prothesis related infections; Staphylococcal infections; Stents; Urokinase-type plasminogen activator