ABSTRACT
Fungi rarely cause infective endocarditis but when they do, they are often associated with poor outcomes. Candida tropicalis accounts for only 10% of Candida endocarditis cases. A case of a 30-year-old male with a history of intravenous drug abuse was reported to the emergency department in August, 2021 with right-sided leg pain and fever for 3 days. A trans-thoracic echocardiogram showed a vegetation on the aortic valve and a computed tomography angiogram showed complete nonopacification of the right-sided common iliac artery and the superficial femoral artery just distal to its branching of the right profunda femoris artery. An emergent right iliofemoral embolectomy was done. Candida tropicalis was isolated from tissue and blood cultures. The patient was successfully treated with aortic valve replacement and intravenous caspofungin. The other reported cases of Candida tropicalis were reviewed and findings were compared with those reported in patients with Candida albicans and Candida parapsilosis endocarditis.
Subject(s)
Antifungal Agents , Candida tropicalis , Candidiasis , Endocarditis , Humans , Candida tropicalis/isolation & purification , Male , Adult , Antifungal Agents/therapeutic use , Candidiasis/diagnosis , Candidiasis/microbiology , Candidiasis/drug therapy , Endocarditis/microbiology , Endocarditis/diagnosis , Endocarditis/drug therapy , Caspofungin/therapeutic use , Substance Abuse, Intravenous/complications , Heart Valve Prosthesis Implantation , Embolectomy/methods , Aortic Valve/surgery , Aortic Valve/microbiology , Aortic Valve/diagnostic imaging , Femoral Artery/surgery , Femoral Artery/microbiology , Femoral Artery/diagnostic imagingABSTRACT
Profunda femoris aneurysms account for only 0.5% of all peripheral artery aneurysms. This case documents a profunda femoris mycotic aneurysm (MA) in a 47-year-old woman, three years post-treatment of bacterial endocarditis. The patient underwent an open surgical excision of the aneurysm with antibiotic cover and made a successful recovery. A literature review was carried out to look at other MA cases to summarise the most common presentations, infective agents and management strategies.
Subject(s)
Aneurysm, Infected/microbiology , Endocarditis, Bacterial/complications , Femoral Artery/microbiology , Aneurysm, Infected/therapy , Anti-Bacterial Agents/therapeutic use , Endocarditis, Bacterial/microbiology , Female , Femoral Artery/surgery , Humans , Middle Aged , Staphylococcus , Streptococcal Infections/complications , Streptococcal Infections/drug therapyABSTRACT
BACKGROUND: Arterial bypass tunneling via the obturator foramen (OFB) can be performed to circumvent groin infections during lower extremity revascularization. The objective of this study is to report safety and efficacy outcomes of OFB in the setting of infected femoral pseudoaneurysms and infected prosthetic femoral bypass grafts. METHODS: A multihospital, single-entity healthcare system retrospective review was conducted for all patients who underwent OFB between January 2014 through June 2020. Any patient >18 years of age who underwent OFB in the setting of groin infection with a minimum of 30 days follow-up was included in the trial. Demographic, operative, and clinical characteristics of patients were gathered during chart review. Statistical analysis was performed using Microsoft Excel and R studio. RESULTS: Seventeen patients underwent OFB during the defined time-period. Demographic data are presented in the first table (Demographic Characteristics). Mean American Society of Anesthesiologists score was 3.25. Mean estimated blood loss was 500 mL. Mean operative time was 307 min. Mean follow-up time was 8.5 months (range 0-35 months). In total, 41.2% patients underwent fluoroscopic-guided tunneling, and, when compared to blind tunneling, showed no difference in intraoperative complications or operative time (P value 0.3). In total, 52.9% of patients required ICU admission resulting in a mean number of 0.8 ICU days. The overall mean length of stay was 16.8 days. Two major amputations were reported during follow-up. Patient mortality within 30 days was 0%. Primary patency within 30 days was 100%. Intravenous drug use was not associated with an increased number of subsequent groin wound procedures (P value 0.3). Intravenous drug use was not associated with concomitant methicillin-resistant Staphylococcus aureus infection (P value 0.3). CONCLUSION: OFB is a safe and effective surgical option in patients who are unable to undergo anatomic tunneling during lower extremity bypass. OFB is associated with favorable rates of primary patency and amputation-free survival at midterm follow-up.
Subject(s)
Aneurysm, False/surgery , Aneurysm, Infected/surgery , Blood Vessel Prosthesis Implantation/adverse effects , Blood Vessel Prosthesis/adverse effects , Femoral Artery/surgery , Lower Extremity/blood supply , Prosthesis-Related Infections/surgery , Adult , Aged , Amputation, Surgical , Aneurysm, False/diagnosis , Aneurysm, False/microbiology , Aneurysm, False/physiopathology , Aneurysm, Infected/diagnosis , Aneurysm, Infected/microbiology , Aneurysm, Infected/physiopathology , Blood Vessel Prosthesis Implantation/instrumentation , Female , Femoral Artery/microbiology , Femoral Artery/physiopathology , Humans , Limb Salvage , Male , Middle Aged , Prosthesis-Related Infections/diagnosis , Prosthesis-Related Infections/microbiology , Prosthesis-Related Infections/physiopathology , Reoperation , Retrospective Studies , Risk Factors , Time Factors , Treatment Outcome , Vascular PatencyABSTRACT
BACKGROUND: The aim of this study is to assess the incidence, clinical manifestations, management, and prognosis of graft infection after bypass surgery with prosthetic conduit for infectious femoral artery pseudoaneurysms (IFAPs) in patients with a history of intravenous drug use (IVDU). METHODS: A single-center retrospective chart review of IVDU presenting with graft infections after previously being treated with extra-anatomic prosthetic conduit bypass surgery for IFAPs between 2009 and 2019 was performed. Relevant clinical data and patient demographics were collected and analyzed. All patients underwent procedures consisting of graft removal with analysis of operative details and complications. RESULTS: Of all 122 patients who underwent IFAP resection with extra-anatomic prosthetic bypass, the incidence of graft infection was 38.5% (47 patients, 48 grafts) with an average age of 35.7 ± 7.3 years. The average interval between bypass surgery and infectious symptoms was 9.2 ± 2.5 months and average time from bypass to graft removal was 13.6 ± 3.4 months. The most common presentation was repeated or unhealable chronic ulcers with sinus formation or purulence either within the bypass area or along the graft conduit route (43, 89.6%). Occlusion of the infected bypass graft occurred in nearly all cases (46, 95.8%). Severe hemorrhage occurred in only 1 case (2.1%). After graft removal, the stumps were ligated in the majority of patients (33, 68.8%) with 15 patients (31.2%) not amenable to ligation due to a difficult dissection. The average time of operation was 35.4 ± 8.7 min with an average blood loss of 35.8 ± 6.7 mL. There were no significant complications such as infection reoccurrence, severe limb ischemia, amputation, or death observed postoperatively. CONCLUSIONS: Patients who receive bypass surgery with prosthetic conduit for IFAPs carry a high incidence of graft infection and subsequent occlusion. However, the presenting symptoms are generally mild, and the incidence of fatal complications is rare. This study suggests that a safe treatment option consists of direct graft removal without reconstruction. Additionally, the procedure proved to be relatively convenient and straightforward, which provides further support toward the strategy of treating IFAPs in IVDUs with pseudoaneurysm resection and prosthetic conduit bypass surgery.
Subject(s)
Aneurysm, False/surgery , Aneurysm, Infected/surgery , Blood Vessel Prosthesis Implantation/adverse effects , Blood Vessel Prosthesis/adverse effects , Device Removal , Femoral Artery/surgery , Prosthesis-Related Infections/surgery , Substance Abuse, Intravenous/complications , Adult , Aneurysm, False/diagnostic imaging , Aneurysm, False/microbiology , Aneurysm, Infected/diagnostic imaging , Aneurysm, Infected/microbiology , Blood Vessel Prosthesis Implantation/instrumentation , Device Removal/adverse effects , Female , Femoral Artery/diagnostic imaging , Femoral Artery/microbiology , Humans , Ligation , Male , Prosthesis-Related Infections/diagnostic imaging , Prosthesis-Related Infections/microbiology , Retrospective Studies , Risk Assessment , Risk Factors , Time Factors , Treatment OutcomeSubject(s)
Blood Vessel Prosthesis Implantation/adverse effects , Blood Vessel Prosthesis/adverse effects , Femoral Artery/surgery , Foreign-Body Migration/etiology , Prosthesis-Related Infections/etiology , Stents/adverse effects , Adult , Blood Vessel Prosthesis Implantation/instrumentation , Device Removal , Female , Femoral Artery/diagnostic imaging , Femoral Artery/microbiology , Foreign-Body Migration/diagnosis , Foreign-Body Migration/microbiology , Foreign-Body Migration/therapy , Humans , Prosthesis-Related Infections/diagnosis , Prosthesis-Related Infections/microbiology , Prosthesis-Related Infections/therapy , Time Factors , Treatment Outcome , Wound HealingABSTRACT
Degenerative aneurysms of the superficial femoral artery (SFA) are relatively rare and often recognized when they become symptomatic such as rupture. Infected SFA aneurysms are much rarer, especially those caused by Campylobacter fetus bacteremia. We report a case of a 67-year-old woman referred to our hospital owing to the presence of a painful reddish swelling on her left thigh. A huge SFA aneurysm rupture was diagnosed, and endovascular treatment with a covered stent was performed. C. fetus was detected in the blood culture thereafter, and antibacterial therapy was successfully performed without any additional surgical interventions. She remained well without any evidence of indolent infection 19 months after the endovascular treatment. The endovascular approach with appropriate prolonged antibacterial therapy would be a feasible alternative for managing selected infected aneurysm cases.
Subject(s)
Aneurysm, Infected/surgery , Aneurysm, Ruptured/surgery , Blood Vessel Prosthesis Implantation , Campylobacter Infections/surgery , Campylobacter fetus/isolation & purification , Endovascular Procedures , Femoral Artery/surgery , Aged , Aneurysm, Infected/diagnostic imaging , Aneurysm, Infected/microbiology , Aneurysm, Ruptured/diagnostic imaging , Aneurysm, Ruptured/microbiology , Anti-Bacterial Agents/therapeutic use , Bacteremia/drug therapy , Bacteremia/microbiology , Blood Vessel Prosthesis , Blood Vessel Prosthesis Implantation/instrumentation , Campylobacter Infections/diagnostic imaging , Campylobacter Infections/microbiology , Endovascular Procedures/instrumentation , Female , Femoral Artery/diagnostic imaging , Femoral Artery/microbiology , Humans , Stents , Treatment OutcomeABSTRACT
PURPOSE: The aim of this study is to show the utility of the combination of thrombin and endograft to solve an urgent situation related to femoral infections. CASE: We present the case of a 91-year-old female patient who underwent a femoral endarterectomy and superficial femoral artery angioplasty and developed a surgical site infection. She was readmitted to the hospital because of bleeding and was operated to suture the femoral patch and to do a plasty of sartorius muscle. Six days after the last intervention a femoral pulsatile mass was noted, and the computed tomography showed a big femoral pseudoaneurysm. Taken again to the theater and via a contralateral puncture a viabahn covered endograft was deployed from the external iliac artery to the yet diseased but patent femoral superficial femoral artery and the pseudoaneurysm was punctured, emptied, and filled with thrombin. The patient was discharged 2 weeks after the last procedure and lived for 10 months (she died because of a nonvascular related cause) with a patent graft and with healed lesions. CONCLUSIONS: In this case the endovascular solution was a definitive solution in a very old patient with several comorbidities.
Subject(s)
Aneurysm, False/therapy , Aneurysm, Infected/therapy , Blood Vessel Prosthesis Implantation , Embolization, Therapeutic , Endovascular Procedures , Femoral Artery , Aged, 80 and over , Aneurysm, False/diagnostic imaging , Aneurysm, False/microbiology , Aneurysm, Infected/diagnostic imaging , Aneurysm, Infected/microbiology , Blood Vessel Prosthesis , Blood Vessel Prosthesis Implantation/instrumentation , Endovascular Procedures/instrumentation , Female , Femoral Artery/diagnostic imaging , Femoral Artery/microbiology , Humans , Treatment OutcomeABSTRACT
Endarterectomy of the common and profunda femoris is currently performed for treatment of atherosclerotic lesions involving femoral bifurcation. Misperception of surgical risk in terms of morbidity and mortality has induced the trend to extend the indication for treatment to patients with mild symptoms at presentation, at the cost of unnecessary increased complication rate and mortality risk, which persists even after patient discharge. We report the case of a giant infected femoral pseudoaneurysm occurring in a 74-year-old patient, previously treated with femoral artery endarterectomy with prosthetic patch closure because of mild claudication. Surgically managed with en block resection and autologous vein reconstruction, his postoperatory course was further complicated by fatal sepsis. Complications for femoral artery endarterectomy, including infectious and fatal events, need a close follow-up of these patients to promptly diagnose and treat any event which may occur, preventing its evolution to more challenging and potentially life-threatening clinical scenario.
Subject(s)
Aneurysm, False/microbiology , Aneurysm, Infected/microbiology , Blood Vessel Prosthesis Implantation/adverse effects , Blood Vessel Prosthesis Implantation/instrumentation , Blood Vessel Prosthesis/adverse effects , Endarterectomy , Femoral Artery/surgery , Intermittent Claudication/surgery , Peripheral Arterial Disease/surgery , Prosthesis-Related Infections/microbiology , Aged , Aneurysm, False/diagnosis , Aneurysm, False/surgery , Aneurysm, Infected/diagnosis , Aneurysm, Infected/surgery , Device Removal , Fatal Outcome , Femoral Artery/microbiology , Humans , Intermittent Claudication/diagnostic imaging , Male , Peripheral Arterial Disease/diagnostic imaging , Prosthesis-Related Infections/diagnosis , Prosthesis-Related Infections/surgery , Saphenous Vein/transplantation , Sepsis/microbiology , Severity of Illness Index , Treatment OutcomeABSTRACT
The present case describes acute and early infection of a superficial femoral artery drug-eluting stent (DES) in a 65-year-old patient 2 days after its implantation in outpatient clinic, with intense clinical presentation. The initial indication was Rutherford 3 peripheral artery disease. Radical treatment by means of stent explantation and femoro-femoral bypass using autogenous vein was performed. Both stent and blood cultures were positive for methicillin-sensitive Staphylococcus aureus. Informative imaging and intraoperative view are provided. Local evolution was satisfactory but endocarditis occurred secondarily. The pathophysiology of this first reported DES infection and the management of the infected vessel are discussed, in light of data derived from coronary literature and open vascular surgery.
Subject(s)
Drug-Eluting Stents/adverse effects , Endovascular Procedures/adverse effects , Endovascular Procedures/instrumentation , Femoral Artery/microbiology , Peripheral Arterial Disease/therapy , Prosthesis-Related Infections/microbiology , Staphylococcal Infections/microbiology , Aged , Anti-Bacterial Agents/therapeutic use , Device Removal , Femoral Artery/diagnostic imaging , Femoral Artery/physiopathology , Femoral Artery/surgery , Humans , Male , Peripheral Arterial Disease/diagnostic imaging , Peripheral Arterial Disease/physiopathology , Prosthesis-Related Infections/diagnosis , Prosthesis-Related Infections/surgery , Saphenous Vein/transplantation , Staphylococcal Infections/diagnosis , Staphylococcal Infections/surgery , Time Factors , Treatment OutcomeSubject(s)
Blood Vessel Prosthesis Implantation/adverse effects , Blood Vessel Prosthesis Implantation/methods , Blood Vessel Prosthesis/adverse effects , Femoral Artery/surgery , Popliteal Artery/surgery , Positron Emission Tomography Computed Tomography , Prosthesis-Related Infections/diagnostic imaging , Stents/adverse effects , Streptococcal Infections/diagnostic imaging , Anti-Bacterial Agents/therapeutic use , Device Removal , Drainage , Femoral Artery/diagnostic imaging , Femoral Artery/microbiology , Humans , Male , Middle Aged , Popliteal Artery/diagnostic imaging , Popliteal Artery/microbiology , Predictive Value of Tests , Prosthesis-Related Infections/microbiology , Prosthesis-Related Infections/surgery , Streptococcal Infections/microbiology , Streptococcal Infections/surgery , Streptococcus agalactiae/isolation & purification , Treatment OutcomeABSTRACT
BACKGROUND: Arterial ligation has been described in the literature as a safe and effective procedure with a relatively low number of patients requiring major amputations. METHODS: We performed a retrospective analysis of a prospectively held database of all patients who underwent arterial ligation for infected femoral pseudoaneurysms due to chronic intravenous drug abuse from January 2012 to March 2018. Information recorded for each patient included age, gender, blood investigations, microbiologic results, diagnostic modality, operative details, outcome of surgery, postoperative complications, and follow-up. RESULTS: There were 25 patients identified, with 2 of them undergoing bilateral ligations. It was more common in men (4:1), and the mean age at presentation was 39.7 years (standard deviation 8.2 y). Nine patients underwent major limb amputation for severe limb ischemia (7 transfemoral amputations and two 53 hip disarticulation). Average hospital stay was 24 days, and there was no mortality. We found a trend with a higher level of arterial ligation, leading to a higher rate of amputation. CONCLUSIONS: Our study is the first to show that there is a trend toward a higher risk of amputation with a higher level of ligation in this cohort of patients, and therefore, we suggest avoidance of external iliac artery ligation even at the most distal part just under the ligament, leaving the circumflex iliac vessel in circuit. Arterial ligation also carries a higher risk of major amputation than previously reported.
Subject(s)
Amputation, Surgical , Aneurysm, False/surgery , Aneurysm, Infected/surgery , Femoral Artery/surgery , Vascular Surgical Procedures/adverse effects , Adult , Aneurysm, False/diagnostic imaging , Aneurysm, False/microbiology , Aneurysm, Infected/diagnostic imaging , Aneurysm, Infected/microbiology , Clinical Decision-Making , Computed Tomography Angiography , Databases, Factual , Female , Femoral Artery/diagnostic imaging , Femoral Artery/microbiology , Humans , Length of Stay , Ligation , Male , Middle Aged , Retrospective Studies , Risk Assessment , Risk Factors , Substance Abuse, Intravenous/complications , Time Factors , Treatment OutcomeABSTRACT
BACKGROUND: The femoral prosthetic patch is a surgical procedure frequently used to treat atherosclerotic lesions involving femoral artery bifurcation. Even though it is an easy to perform procedure, surgical management of complications, first of all graft infection, may be challenging, with a high morbidity and mortality risk for patients. We report our experience on surgical treatment of femoral patch infections. MATERIALS AND METHODS: Between April 2012 and April 2018, 26 patients (26 limbs) were referred to the emergency department at our institution for the treatment of femoral prosthetic patch infections. None of the patients had been previously treated at our institution. All patients underwent a wide debridement of the infection site. Blood flow was restored through a vein interposition graft anastomosed at least 4-5 cm from the site of infection. End points of the study were death-related events, major or minor limb loss (major loss for above or below the knee amputation and minor for foot or toe), vein interposition graft failures, recurrent graft infections, or surgical wound healing. RESULTS: A total of 26 patients (21 male and 5 female patients) underwent surgical treatment. The mean age of patients was 69 years. The majority of our patients (54%) had been previously treated with an isolated femoral artery prosthetic patch. Three (11%) patients had been treated with a bilateral prosthetic femoral patch, but only one side was infected. After debridement of the infection site, we used the great saphenous vein to revascularize the lower limb in 22 (85%) cases, whereas the cephalic vein was used in only 4 cases (15%). The 5-year survival rate was 81% (standard error [SE] = 0.12). The 5-year primary patency rate was 70% (SE = 0.14). During follow-up, 4 graft occlusions occurred, and in 2 cases, a major amputation was required. The limb salvage rate at 5 years was 81% (SE = 0.13). CONCLUSIONS: An infection can complicate the femoral prosthetic patch carrying a high rate of morbidity, mortality, and limb loss. Surgical indication for a primary procedure must be restricted to critical limb ischemia, and it must be associated to a multilevel correction of the atherosclerotic disease.
Subject(s)
Blood Vessel Prosthesis Implantation/adverse effects , Blood Vessel Prosthesis/adverse effects , Endarterectomy/adverse effects , Femoral Artery/surgery , Peripheral Arterial Disease/surgery , Prosthesis-Related Infections/microbiology , Aged , Amputation, Surgical , Blood Vessel Prosthesis Implantation/instrumentation , Blood Vessel Prosthesis Implantation/mortality , Computed Tomography Angiography , Debridement , Endarterectomy/instrumentation , Endarterectomy/mortality , Female , Femoral Artery/diagnostic imaging , Femoral Artery/microbiology , Graft Occlusion, Vascular/etiology , Graft Occlusion, Vascular/physiopathology , Humans , Limb Salvage , Male , Middle Aged , Peripheral Arterial Disease/diagnostic imaging , Prosthesis-Related Infections/diagnostic imaging , Prosthesis-Related Infections/mortality , Prosthesis-Related Infections/surgery , Reoperation , Retrospective Studies , Risk Factors , Saphenous Vein/transplantation , Time Factors , Treatment Outcome , Vascular PatencySubject(s)
Blood Vessel Prosthesis Implantation/adverse effects , Blood Vessel Prosthesis Implantation/instrumentation , Blood Vessel Prosthesis/adverse effects , Femoral Artery/surgery , Peripheral Arterial Disease/surgery , Prosthesis-Related Infections/microbiology , Pseudomonas Infections/microbiology , Anti-Bacterial Agents/therapeutic use , Device Removal , Drainage , Female , Femoral Artery/microbiology , Humans , Middle Aged , Prosthesis-Related Infections/diagnosis , Prosthesis-Related Infections/therapy , Pseudomonas Infections/diagnosis , Pseudomonas Infections/therapy , Therapeutic Irrigation , Treatment OutcomeABSTRACT
In recent years, endovascular procedures have become a first-line therapy for peripheral arterial disease. As a result, an increased number of patients received stent grafts to treat their persistent superficial femoral artery (SFA) lesions. Although the risk of stent-graft infection in that location exists, it is exceptionally rare. Successful management of this condition requires removal of the infected stent graft in combination with appropriate antibiotic therapy and debridement of necrotic tissue, as well as revascularization, with avoidance of prosthetic material. We describe 2 cases of infected stent grafts in the SFA that presented late after the original intervention. An 83-year-old man presented 8 years after the original operation, and a 57-year-old woman presented 2 years after the original operation. Both infected stent grafts were excised, and complete destruction of the native arterial wall was evident during exploration.
Subject(s)
Blood Vessel Prosthesis Implantation/adverse effects , Device Removal , Endovascular Procedures/adverse effects , Femoral Artery/surgery , Peripheral Arterial Disease/surgery , Prosthesis-Related Infections/surgery , Stents , Aged, 80 and over , Anti-Bacterial Agents/therapeutic use , Blood Vessel Prosthesis Implantation/instrumentation , Computed Tomography Angiography , Debridement , Endovascular Procedures/instrumentation , Female , Femoral Artery/microbiology , Humans , Male , Middle Aged , Prosthesis Design , Prosthesis-Related Infections/diagnosis , Prosthesis-Related Infections/microbiology , Risk Factors , Treatment Outcome , Ultrasonography, Doppler, DuplexABSTRACT
BACKGROUND: Hybrid revascularization combines open lower extremity surgery and endovascular procedures to simultaneously treat atherosclerotic lesions on multiple levels in patients with peripheral arterial occlusive disease (PAD). Hybrid surgery appears to be a safe strategy for multilevel stenosis revascularization, though the risk of surgical site infection (SSI) has not been clearly investigated. This study evaluates the development of SSI following common femoral artery endarterectomy (CFE) and hybrid revascularization procedures. METHODS: A retrospective study was performed including all patients undergoing CFE, as standalone or as part of a hybrid procedure, due to PAD between January 2013 and December 2016. Preoperative, intraoperative, clinical, and follow-up information was gathered prospectively and reviewed retrospectively. The presence of SSI was recorded based on criteria of the Centre for Disease Control. RESULTS: A total of 229 CFEs were performed. One hundred thirty-two as a standalone procedure, 65 combined with iliofemoral angioplasty, and 32 combined with peripheral angioplasty. Nineteen patients (8.3%) developed an SSI, of which 4 were deep infections. Ten infections (7.6%) occurred in the CFE-only group, 5 (7.7%) in the iliofemoral hybrid group, and 4 (12.5%) in the peripheral hybrid group (P = 0.65). Five patients (2.1%) required surgery to control the infection. The mean duration of stay was 5 days for patients without SSI versus 20 days for patients who developed an SSI (P < 0.0001). CONCLUSIONS: The hybrid procedure combining open femoral endarterectomy with endovascular revascularization is a safe procedure with no significant differences in infection rates between open surgery, central, or peripheral hybrid revascularization.
Subject(s)
Angioplasty/adverse effects , Endarterectomy/adverse effects , Femoral Artery/surgery , Lower Extremity/blood supply , Peripheral Arterial Disease/surgery , Surgical Wound Infection/microbiology , Aged , Aged, 80 and over , Female , Femoral Artery/diagnostic imaging , Femoral Artery/microbiology , Humans , Length of Stay , Male , Middle Aged , Peripheral Arterial Disease/diagnosis , Retrospective Studies , Risk Assessment , Risk Factors , Surgical Wound Infection/diagnosis , Surgical Wound Infection/therapy , Time Factors , Treatment OutcomeABSTRACT
BACKGROUND: This study details 2-year outcomes of a modified gracilis muscle flap (GMF) technique in providing tissue coverage for groin complications after arterial bypass surgery with synthetic graft. METHODS: All patients who developed groin infections after lower extremity arterial bypass with synthetic graft who underwent a GMF technique were included from June 2014 to March 2017 from a prospectively collected, purpose-built institutional database. Modifications to the standard technique included identification of the muscle using ultrasound to ensure precise skip incisions, preservation of the segmental blood supply, widening of the tunnel through which the muscle is retroflexed, placement of a wound vacuum-assisted closure for healing, and lifelong antibiotics. Demographics, laboratory values, bypass procedure, length of stay (LOS), disposition, and 1-, 3-, 6-, 12-, and 24-month follow-up data were collected. Analysis was performed via descriptive statistics. RESULTS: Over the 3-year study period, 22 patients underwent GMF after complications resulted from arterial bypass surgery. Types of bypass included aortobifemoral (32%), axillobifemoral (14%), femoral-femoral (23%), femoral-popliteal or mixed distal (27%), and thigh graft for dialysis (4%). Forty-five percentage of patients presented with graft infection, 50% with wound dehiscence, and 5% with graft disruption and bleeding. Only 23% of patients were candidates for sartorius muscle flap at the time of their initial procedure. The average case length was 64 + 19 min. Sixty-four percentage of patients were discharged home with home health care and the remainder to a skilled nursing facility. The average LOS was 6.1 + 3.4 days. Fifty-four percentages of wounds were healed at 1 month and 100% at 3 months with adjunctive vacuum-assisted closure therapy and lifelong antibiotics. Sixty percentage of patients were still alive at 24 months, with 33% of grafts still patent at that time. Median survival was 18.1 months, and median graft patency was 17.9 months. CONCLUSIONS: GMF is a safe and effective treatment for groin complications after arterial bypass surgery with synthetic graft. Owing to its versatility, area of coverage, ease of use, and durability, it potentially should be considered as a primary form of muscle coverage for groin complications.
Subject(s)
Blood Vessel Prosthesis Implantation/adverse effects , Blood Vessel Prosthesis Implantation/instrumentation , Blood Vessel Prosthesis/adverse effects , Femoral Artery/surgery , Gracilis Muscle/surgery , Groin/surgery , Lower Extremity/blood supply , Myocutaneous Flap/surgery , Prosthesis-Related Infections/surgery , Surgical Wound Infection/surgery , Aged , Aged, 80 and over , Anti-Bacterial Agents/administration & dosage , Databases, Factual , Female , Femoral Artery/diagnostic imaging , Femoral Artery/microbiology , Femoral Artery/physiopathology , Gracilis Muscle/diagnostic imaging , Groin/microbiology , Humans , Kaplan-Meier Estimate , Length of Stay , Male , Negative-Pressure Wound Therapy , Patient Discharge , Prosthesis-Related Infections/diagnosis , Prosthesis-Related Infections/microbiology , Prosthesis-Related Infections/physiopathology , Retrospective Studies , Risk Factors , Surgical Wound Infection/diagnosis , Surgical Wound Infection/microbiology , Time Factors , Treatment Outcome , Vascular Patency , Wound HealingABSTRACT
Pseudoaneurysm in Salmonella infection is a rare complication of lupus. We describe a 51-year-old woman with lupus who suffered from swelling and painful sensation of right lower limbs. The Doppler ultrasound study revealed a large pseudoaneurysm of right superficial femoral artery and the tissue culture was Salmonella group D. Surgical repair with stent grafting was performed successfully. This vascular complication with Salmonella infection has not been previously described in lupus.
Subject(s)
Aneurysm, False/diagnostic imaging , Femoral Artery/diagnostic imaging , Lupus Erythematosus, Systemic/complications , Salmonella Infections/complications , Aneurysm, False/complications , Aneurysm, False/microbiology , Angiography , Anti-Bacterial Agents/therapeutic use , Ciprofloxacin/therapeutic use , Female , Femoral Artery/microbiology , Humans , Immunocompetence , Lower Extremity/diagnostic imaging , Middle Aged , Positron-Emission Tomography , Salmonella/isolation & purification , Salmonella Infections/drug therapy , Stents , Ultrasonography, Doppler, ColorABSTRACT
The potent immunosuppressive drugs used by transplant recipients place them at risk of infections. Data on infective endocarditis (IE) in the setting of renal transplantation (RT) are sparse. We describe a 36-year-old woman referred to a tertiary medical center for evaluation of elevated creatinine levels 1 month after a second RT. Work-up revealed the presence of all four of Duke's criteria: fever, persistent bacteremia, new-onset tricuspid regurgitation, and masses suspected to be vegetation attached to the tricuspid annulus. Symptoms resolved with antibiotic treatment and fluids. Fluorodeoxyglucose-positron emission tomography/computed tomography (FDG-PET/CT) revealed hypermetabolic absorption in the femoral vascular graft that had been used for hemodialysis prior to transplantation. The graft was removed by open surgery, and the patient was discharged home in good condition with continued antibiotic treatment. Review of the literature yielded 73 previously reported cases of IE in renal transplant recipients. Several differences were noted from IE in the general population: lower male predominance, younger age (<60 years), absence in most cases of a preexisting structural cardiac anomaly, and more variable causative pathogens. Our case also highlights the importance of FDG-PET/CT for detecting the source of IE and alerts clinicians to the sometimes unexpected course of the disease in renal transplant recipients.
Subject(s)
Endocarditis, Bacterial/diagnosis , Kidney Failure, Chronic/therapy , Kidney Transplantation/adverse effects , Klebsiella Infections/diagnosis , Prosthesis-Related Infections/diagnosis , Renal Dialysis/adverse effects , Adult , Anti-Bacterial Agents/therapeutic use , Blood Vessel Prosthesis/microbiology , Endocarditis, Bacterial/blood , Endocarditis, Bacterial/microbiology , Endocarditis, Bacterial/surgery , Female , Femoral Artery/diagnostic imaging , Femoral Artery/microbiology , Femoral Artery/transplantation , Fluorodeoxyglucose F18/administration & dosage , Humans , Immunosuppressive Agents/adverse effects , Klebsiella Infections/blood , Klebsiella Infections/microbiology , Klebsiella Infections/surgery , Klebsiella pneumoniae/isolation & purification , Klebsiella pneumoniae/pathogenicity , Positron Emission Tomography Computed Tomography/methods , Prosthesis-Related Infections/blood , Prosthesis-Related Infections/microbiology , Prosthesis-Related Infections/surgery , Radiopharmaceuticals/administration & dosageSubject(s)
Aneurysm, False/surgery , Aneurysm, Infected/surgery , Blood Vessel Prosthesis Implantation , Endovascular Procedures , Femoral Artery/surgery , Staphylococcal Infections/surgery , Aneurysm, False/diagnostic imaging , Aneurysm, False/microbiology , Aneurysm, Infected/diagnostic imaging , Aneurysm, Infected/microbiology , Blood Vessel Prosthesis , Blood Vessel Prosthesis Implantation/instrumentation , Computed Tomography Angiography , Endovascular Procedures/instrumentation , Female , Femoral Artery/diagnostic imaging , Femoral Artery/microbiology , Humans , Staphylococcal Infections/diagnostic imaging , Staphylococcal Infections/microbiology , Stents , Treatment OutcomeABSTRACT
Objectives The reported annual incidence of mycotic pseudoaneurysm of the common femoral artery in intravenous drug users has been estimated at 0.03%. Over the past 5 years in Scotland, the proportion of people receiving specialist attention for heroin use over the age of 40 years has increased from 15 to 22%. Although routinely managed with arterial ligation (without reconstruction), some series have reported rates of major limb amputation of up to 10%. We sought to define whether this management strategy was still acceptable in an older population. Methods Retrospective review of patients presenting to a tertiary vascular service with mycotic pseudoaneurysm of the common femoral artery due to arterial injection by intravenous drug users between October 2010 and March 2016. Variables of interest included patient demographics and requirement for major amputation. Results There were 55 patients identified. The annual incidence of mycotic pseudoaneurysm of the common femoral artery in intravenous drug users was 2.1%. It was more common in men (3:1) and the mean age at presentation was 41 years (standard deviation ± 8 years). Three patients underwent major limb amputation during the index admission for severe limb ischaemia (two transfemoral amputations; one hip-disarticulation). Following discharge two patients were readmitted (134 and 200 days, respectively, following primary ligation) for major limb amputation due to of critical limb ischaemia. Conclusions Despite the increasing age of intravenous drug users presenting with mycotic pseudoaneurysm of the common femoral artery primary ligation of pseudoaneurysm would seem to remain an appropriate therapeutic intervention.