Septic endarteritis due to vascular closure device infection
71st Annual Scientific Session and Expo of the American-College-of-Cardiology (ACC), Washington, DC, April 2 – 4, 2022.
Vascular closure devices are increasingly used for hemostasis after femoral access. Although infectious complications are uncommon, they are associated with high morbidity and mortality.
A 57-year-old man underwent a stent-assisted coil embolization for a left anterior communicating artery aneurysm via right femoral access. A vascular closure device with braided suture was used for hemostasis. Four days later, he presented with fever and right inguinal pain and swelling. A well-circumscribed tender area of induration to his right groin was palpated. A right lower extremity arterial duplex ultrasound showed no hematoma, pseudoaneurysm, or arterio-venous fistula. Computed tomography showed moderate, nonspecific, subcutaneous right inguinal edema without abscess. He was started on vancomycin for suspected cellulitis. Blood cultures were persistently positive for methicillin-resistant Staphylococcus aureus. He developed a macular rash involving the unilateral sole of his foot that extended to the right leg. He was taken expeditiously for operative exploration and was found with areas of fat necrosis and pockets of purulent drainage. Dissection and mobilization of the common femoral artery revealed a necrotic anterior arterial wall at the point of closure device entry. The closure device was excised. Debridement of the arterial wall was performed. A segment of proximal ipsilateral greater saphenous vein was harvested and used to perform a vein patch closure of the common femoral artery, followed by rotation of a sartorius muscle flap.
After initially presenting as cellulitis, the presence of a unilateral localized macular rash, attributed to septic emboli, with persistent bacteremia prompted thorough evaluation for a septic source. An infected vascular closure device was considered which led to a vascular surgery consultation and definitive surgical management for septic endarteritis.
Increased awareness of the infectious potential of vascular closure devices is warranted, given their widespread use in endovascular interventions. Early recognition and prompt surgical management are essential to improve outcomes.