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Septic complications after cardiac catheterization and percutaneous transluminal coronary angioplasty
R A McCready1, H Siderys, J N Pittman
1Division of Cardiovascular Surgery, Methodist Hospital of Indiana, Indianapolis.
Insights
Septic complications following cardiac procedures are rare but serious. Repeat femoral artery puncture or prolonged sheath use increases infection risk, potentially leading to severe outcomes like death or infected aneurysms.
Area of Science:
- Cardiology
- Infectious Diseases
- Vascular Surgery
Background:
- Septic complications after cardiac catheterization and percutaneous transluminal coronary angioplasty (PTCA) are uncommon.
- This study investigates a series of nine patients experiencing severe sepsis post-procedure.
Observation:
- A common factor in these cases was repeat ipsilateral femoral artery puncture.
- Prolonged femoral artery sheath indwelling (1-5 days) was also identified as a significant risk factor.
- Two patients died from septic complications, including bacterial endocarditis and infected retroperitoneal hematoma.
Findings:
- Colonization of the needle tract by skin flora contributes to septic complications.
- Repeat arterial punctures or sheath indwelling >24 hours increase this risk.
- Infected aneurysms developed in three patients, requiring intervention.
Implications:
- Prompt antibiotic treatment targeting gram-positive organisms is crucial for sepsis management.
- Advanced imaging like CT or angiography is recommended for persistent sepsis or suspected complications.
- Infected aneurysms necessitate surgical intervention (resection or ligation) due to rupture risk.
Abstract:
Septic complications after cardiac catheterization and percutaneous transluminal coronary artery angioplasty are distinctly uncommon. However, we have recently treated nine patients with sepsis and life-threatening complications after cardiac catheterization alone or after catheterization and subsequent percutaneous transluminal coronary angioplasty. The common denominator in all patients was either repeat puncturing of the ipsilateral femoral artery or leaving the femoral artery sheath in for 1 to 5 days after the procedure. Two patients died as a direct result of their septic complications. One death occurred in a patient in whom bacterial endocarditis with congestive heart failure developed, and the other patient had a large retroperitoneal hematoma that became secondarily infected. Infected aneurysms that were successfully treated developed in three patients. Our study suggests that colonization of the needle tract by skin flora predisposes to septic complications if repeat arterial punctures are required or if a femoral artery sheath is left in place for more than 24 hours. Patients in whom sepsis develops after these procedures should be initially treated with antibiotics effective against gram-positive organisms. CT scanning or angiography should be considered for patients with persistent sepsis, septic emboli, and abdominal or flank pain. Infected aneurysms require resection or ligation because of the propensity of these aneurysms to rupture.