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A Journal on Surgery
Indexed/Abstracted in: EMBASE, Scopus, Emerging Sources Citation Index
Chirurgia 2012 June;25(3):229-33
Iliac artery stent infection successfully treated with circumvented in situ Y-grafting and Omental wrapping
Tanaka K., Naruse Y., Tabata A.
Department of Cardiovascular Surgery, Cardiovascular Center, Toranomon Hospital, Tokyo, Japan
Stent infection is a rare complication of percutaneous transluminal angioplasty but can have serious consequences. To ensure complete elimination of the infection, optimal management should include a surgical approach instead of only antibiotic therapy. Here, we report a case of stent infection that was successfully treated with antibiotic therapy and surgery. A 58-year-old man had undergone left iliac artery angioplasty and stent placement (Palmaz stent and Easy Wallstent). Three years later, he was admitted with fever and left lower-extremity pain associated with scattered petechiae. Staphylococcus aureus was detected on blood culture. Computed tomography showed a left iliac artery pseudoaneurysm with severe inflammatory changes in the surrounding tissue. Although the patient responded to antibiotic therapy, surgery was performed because the inflammatory changes were persistent. In situ Y-grafting was performed using a prosthetic graft. The left limb of the bifurcated graft circumvented the infected space, ran along the right limb, and passed forward to the bladder, and it was anastomosed to the external iliac artery in the left groin. To prevent recurrent graft infection and fill the debrided cavity, omental wrapping was performed. Histological examination of the removed stent confirmed marked neutrophilic infiltration and the presence of bacterial colonies. The patient was discharged after antibiotic therapy for 6 weeks postoperation, although he received oral antibiotics for an additional 6 months. Until postoperative month 18, the infection has not recurred. We conclude that circumvented in situ Y-grafting with omental wrapping is a safe and reliable surgical method for treating iliac artery stent infection.