Department of Surgery, Rijnland Hospital Leiderdorp, The Netherlands.
Department of Surgery, Rijnland Hospital Leiderdorp, The Netherlands.
Eur J Vasc Endovasc Surg. 2014 Jan;47(1):87-99. doi: 10.1016/j.ejvs.2013.10.006. Epub 2013 Oct 22.
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.
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.
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.
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.
本文旨在报道一例左髂总动脉感染的裸金属支架，该支架通过紧急手术取出，并对冠状动脉和非冠状动脉金属支架感染的诊断和转归的文献进行综述。
通过系统检索 Medline 数据库，确定了冠状动脉和非冠状动脉裸金属支架感染的危险因素、体征和症状、影像学策略和治疗方式。
共纳入并分析了 76 项额外的研究/病例报告（48 项非冠状动脉；29 项冠状动脉）。血管内裸金属支架感染是一种罕见但严重的并发症，常导致急诊手术（总体：75.3%；非冠状动脉病例：83.3%；冠状动脉病例：62.1%）。在 25.0%的非冠状动脉病例中，感染导致肢体截肢或内脏切除。报告的死亡率高达病例的 32.5%（非冠状动脉：22.9%；冠状动脉：48.3%）。当患者在支架置入后出现发热、寒战等非特异性症状时，医生应始终怀疑支架感染。额外的影像学检查可用于检测假性动脉瘤的存在。PET-CT 是识别支架感染的理想媒介。
血管内支架感染与高发病率和死亡率相关。手术是首选的治疗选择，但并非总是可行，尤其是在冠状动脉支架患者中。在某些情况下，通过在支架置入时使用预防性抗生素，可以预防裸金属支架感染。
