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Septic peripheral embolization from bacterial and fungal endocarditis
J A Freischlag1, H A Asbun, M M Sedwitz
1Department of Surgery, VA Medical Center, San Diego, California.
Annals of Vascular Surgery
|October 1, 1989
Summary
Arterial embolization from infectious endocarditis can cause lower extremity ischemia. Prompt surgical intervention and antimicrobial therapy improve limb salvage rates, but fungal cases have a poorer prognosis.
Area of Science:
- Cardiology
- Vascular Surgery
- Infectious Diseases
Background:
- Arterial embolization is a significant complication of infectious endocarditis, potentially leading to limb ischemia.
- Increased survival rates due to antibiotics and valve surgery have led to more frequent embolic events.
Observation:
- Six patients with infectious endocarditis presented with lower extremity ischemia over two years.
- Four cases involved Gram-positive bacterial endocarditis; two involved fungal endocarditis in immunosuppressed patients.
Findings:
- All patients underwent lower extremity embolectomy or bypass grafting and received long-term antimicrobial/antifungal therapy.
- Cardiac valve replacement was necessary for all six patients, resulting in successful reperfusion and no amputations.
- While bacterial endocarditis patients survived, fungal endocarditis patients ultimately died.
Implications:
- Aggressive management including arteriography, embolectomy, and valve replacement is crucial for limb salvage in endocarditis-related arterial embolism.
- Early intervention offers the best chance for survival and limb preservation.
- Fungal endocarditis carries a higher mortality risk compared to bacterial endocarditis in this context.