Malek A M, Higashida R T, Reilly L M, Smith W S, Kang S M, Gress D R, Meyers P M, Phatouros C C, Halbach V V, Dowd C F
Department of Radiology, Division of Interventional Neurovascular Radiology, University of California, San Francisco, CA 94143, USA.
Cardiovasc Intervent Radiol. 2000 Jan-Feb;23(1):57-60. doi: 10.1007/s002709910009.
Technically uncomplicated percutaneous angioplasty and stent placement of a left subclavian artery stenosis was performed in a 56-year-old man for treatment of subclavian steal syndrome and vertebrobasilar insufficiency. Six days later the patient was readmitted with Staphylococcus aureus bacteremia and stigmata of septic emboli isolated to the ipsilateral hand. Nine days later he had computed tomography (CT) evidence of a contrast-enhancing phlegmon surrounding the stent. Despite clinical improvement and resolution of bacteremia on intravenous antibiotic therapy, the phlegmon progressed, and at day 21 a pseudoaneurysm was angiographically confirmed. The patient underwent surgical removal of the stented arterial segment and successful autogenous arterial reconstruction. The possible contributory factors leading to stent infection were prolonged right femoral artery access and an infected left arm venous access. Although the role of prophylactic antibiotics remains to be defined, it may be important in cases where the vascular access sheath remains in place for a prolonged period of time.
对一名56岁男性患者进行了技术上无并发症的经皮血管成形术及左锁骨下动脉狭窄支架置入术，以治疗锁骨下动脉盗血综合征和椎基底动脉供血不足。六天后，患者因金黄色葡萄球菌菌血症及仅累及同侧手部的感染性栓子迹象再次入院。九天后，计算机断层扫描（CT）显示支架周围有强化的蜂窝织炎。尽管静脉使用抗生素治疗后临床症状改善且菌血症消退，但蜂窝织炎仍进展，在第21天血管造影证实有假性动脉瘤形成。患者接受了手术切除带支架的动脉段并成功进行了自体动脉重建。导致支架感染的可能因素为右股动脉入路时间延长和左臂静脉入路感染。尽管预防性抗生素的作用尚待确定，但在血管入路鞘长时间留置的情况下可能很重要。
