The April 2013 issue of Vascular Disease Management includes a Case Files by Dr. George case report of a man who developed new onset left leg parasthesias, discoloration, and pulselessness 2 days after surgical mitral valve replacement, removal of infected pacemaker leads, and reimplantation of a new device. In this case, authors Rajeev Mareddy, DO, and Jon C. George, MD, deemed the patient high risk for repeat vascular surgery, and approached the acute limb ischemia (ALI) caused by the infective endocarditis endovascularly.
As discussed by the authors, thrombolysis is avoided in patients with septic embolization because of concerns about concurrent intracerebral mycotic aneurysms and the risk of hemorrhage. This patient underwent percutaneous mechanical thrombectomy (PMT) and had reperfusion of his left lower extremity with resolution of symptoms, and he was discharged on hospital day 17 with a 6-week course of intravenous antibiotics.
The authors suggest that PMT may be a viable option for ALI caused by emboli secondary to an infective source. Read more and share your own clinical experience at “Endovascular Management of Acute Limb Ischemia from Septic Emboli.”