Septic embolization from stented arteriovenous fistula

Area of Science:

• Vascular Surgery
• Infectious Diseases
• Interventional Radiology

Background:

• Arteriovenous fistulas (AVFs) are crucial for hemodialysis access.
• Juxta-anastomotic stenosis is a common complication affecting AVF patency.
• Percutaneous interventions, including covered stent placement, are used to treat stenosis.

Observation:

• A 69-year-old male developed systemic sepsis one year after receiving a covered stent for juxta-anastomotic AVF stenosis.
• The infected stent graft was identified as the source of bacteremia and septic pulmonary emboli.
• The patient required explantation of the infected stent graft and revision of the AVF.

Findings:

• Infected stent grafts, though rare, can serve as a nidus for serious systemic infection.
• Bacteremia and septic pulmonary emboli are potential complications of infected endovascular devices.
• Successful management involved removal of the infected graft and surgical AVF revision.

Implications:

• This case underscores the importance of considering infection in patients with AVFs presenting with sepsis, even after endovascular intervention.
• It highlights a unique complication of covered stent use in AVF management.
• Further research may be warranted to elucidate risk factors and preventative strategies for stent graft infection in AVFs.