Kaldas Matthew, Gonzalez Rubiano Sofia, Pendowski Benjamin, Greene John, Kis Bela
Internal Medicine, Nova Southeastern University Dr. Kiran C. Patel College of Osteopathic Medicine, Tampa, USA.
Internal Medicine, Moffitt Cancer Center, Tampa, USA.
Cureus. 2025 Aug 6;17(8):e89484. doi: 10.7759/cureus.89484. eCollection 2025 Aug.
Endovascular coil embolization is an effective, minimally invasive technique used to treat visceral pseudoaneurysms. Although rare, post-procedural infections such as bacteremia and infective endocarditis (IE) can occur, particularly in patients with underlying malignancy, valvular abnormalities, or immunosuppression. Early recognition and intervention are critical to preventing serious complications. A 52-year-old male with a history of renal cell carcinoma (post left nephrectomy) and a known heart murmur presented to the hospital with worsening left-sided abdominal pain. Imaging revealed multiple visceral pseudoaneurysms involving the hepatic, splenic, and mesenteric arteries. He underwent successful coil and glue embolization. Further workup with transesophageal echocardiography (TEE) revealed severe mitral regurgitation with vegetations and a flail posterior mitral leaflet. Blood cultures obtained after the embolization procedure were positive for , confirming IE, and the patient subsequently underwent mitral valve replacement and pacemaker implantation at a cardiac hospital. He completed intravenous antibiotic therapy and was discharged in stable condition. Eighteen-month follow-up imaging showed evolving splenic infarcts without evidence of visceral pseudoaneurysms. This case highlights a rare but serious complication of coil embolization. While the causal link cannot be definitively confirmed, the sequence of events and known mechanisms of post-procedural bacteremia support a strong association. Factors such as the introduction of foreign material, ischemia-induced tissue vulnerability, and the presence of underlying malignancy may increase the risk of hematogenous bacterial seeding. , though classically associated with dental flora, can exhibit invasive potential in vulnerable hosts. Cancer patients face elevated risks due to frequent vascular instrumentation and immunosuppressive treatments. High-risk patients may benefit from close post-procedural monitoring and early infectious workup. This case highlights the importance of species-level identification and clinical vigilance in preventing delayed diagnosis and complications.
血管内弹簧圈栓塞术是一种用于治疗内脏假性动脉瘤的有效、微创技术。尽管罕见，但术后感染如菌血症和感染性心内膜炎（IE）仍可能发生，尤其是在有潜在恶性肿瘤、瓣膜异常或免疫抑制的患者中。早期识别和干预对于预防严重并发症至关重要。一名52岁男性，有肾细胞癌病史（左肾切除术后）且已知有心脏杂音，因左侧腹痛加重入院。影像学检查发现多个内脏假性动脉瘤，累及肝动脉、脾动脉和肠系膜动脉。他成功接受了弹簧圈和胶水栓塞治疗。经食管超声心动图（TEE）进一步检查发现严重二尖瓣反流伴赘生物和二尖瓣后叶连枷样改变。栓塞术后获得的血培养结果显示 阳性，确诊为IE，随后该患者在一家心脏医院接受了二尖瓣置换术和起搏器植入术。他完成了静脉抗生素治疗，出院时病情稳定。18个月的随访影像学检查显示脾梗死在进展，未发现内脏假性动脉瘤。 本病例突出了弹簧圈栓塞术一种罕见但严重的并发症。虽然因果关系不能最终确定，但事件的先后顺序和术后菌血症的已知机制支持两者有很强的关联。诸如引入异物、缺血导致组织易损性以及存在潜在恶性肿瘤等因素可能会增加血源性细菌播散的风险。 虽然传统上与口腔菌群有关，但在易感宿主中可能具有侵袭性。癌症患者由于频繁的血管介入操作和免疫抑制治疗，面临的风险更高。高危患者可能受益于术后密切监测和早期感染性检查。本病例突出了在预防延迟诊断和并发症方面进行菌种水平鉴定和临床警惕的重要性。
