Peripheral septic arterial embolism of non-cardiac source: A systematic review of literature

Abstract

Peripheral septic arterial embolism of non-cardiac source (NCPSRE) is a rare event, and scientific literature is scanty. The objective of this paper is to carry out a systematic review on this topic. Materials and methods: a computerized search was conducted using PubMed from 1946 to 2014. Results: A total of 43 papers describing 53 patients were identified. Staphylococcus aureus was the most frequently involved germ in the infection (32/53 cases). The most frequent cause was arterial complications after catheter insertion for therapeutic or diagnostic procedures (29/53), followed by complications of previous vascular bypass (8/53) and aspergillosis (10/53). Diagnosis was made essentially through blood culture (35/53 cases) and biopsy of skin lesions (15/53). A specific antibiotic therapy was helpful in the majority of patients (35/53) and 36/53 patients underwent surgical procedures. Eleven patients died: seven of these were affected by aspergillosis; two cases were recorded during surgery; another two patients died of different causes. Conclusions: NCPSRE should always be suspected in patients who have undergone invasive diagnostic and therapeutic vascular procedures, in patients submitted to radial artery catheter insertion, in cases of aortofemoral bypass followed by gastro-intestinal bleeding, in patients presenting sudden acute ischemia of the lower limb, accompanied by fever, leukocytosis, cutaneous petechiae or purpuric macules or a painful mass associated with a pseudoaneurysm at the site of a catheter insertion. In immunocompromised hosts, NCPSRE may indicate a diagnosis of aspergillosis, and a skin biopsy and chest X-ray should be performed promptly.