Septic endarteritis of the femoral artery following angioplasty

A case of septic endarteritis that occurred in the femoral artery following percutaneous transluminal coronary angioplasty (PTCA) is reported, and nine previously reported cases of this complication are reviewed. In each case Staphylococcus aureus was identified as the pathogen. For all case in which a complete clinical description was available, endarteritis occurred following repeated PTCA or repuncture PTCA (i.e., a second catheterization at the original site of insertion for diagnostic purposes). The characteristic manifestations of endarteritis in this setting included bacteremia (all 10 cases), the formation of a pseudoaneurysm (six), distal emboli (five), and regional septic arthritis or osteomyelitis (five of six cases that included the information needed to determine the presence of these conditions). In each case, treatment included 4-6 weeks of iv antibiotics and surgery, most frequently resection of the pseudoaneurysm and vascular bypass. We recommend surveillance for the signs of endarteritis, especially after repeated catheterization, and use of the contralateral site when repeated catheterization is indicated. When the ipsilateral site is used, the administration of prophylactic antibiotics should be considered.