Bacterial endarteritis. A probable case in an arteriovenous fistula used for long-term hemodialysis.
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We report a case of bacterial arteritis of the external iliac artery complicated by mycotic aneurysm following coronary angioplasty. To our knowledge, this is the first reported instance of arterial wall infection caused by coronary angioplasty at a distance from the insertion site equal to the length of the sheath.
Experimental aortic intimal thickening has been induced in rabbits by sheathing the vessel with a polyethylene cuff. The alterations have been examined by light and transmission electron microscopy, during 12 months. An irregular intimal thickening develops as soon as the 15th day and includes numerous myofibroblasts with some other cells of monocytic or endothelial type. Microfibrils, elastic aggregates and collagen fibers are found in the intercellular space. Simultaneously, the media undergoes a fragmentation of the elastic laminae and the adventitia shows a capillary angiectasis and a granuloma. After 3 months there is, between the intimal smooth muscle cells, a progressive increase of elastic and collagenous material. In the media, elastic break up becomes more frequent after the 4th month and myocytes appear increasingly atrophic, which facilitates the extension of fibrosis. This is accompanied at times by a thinning of the arterial wall with or without localized disappearance of the media. All these modifications are discussed and compared to what we had previously found in the femoral artery [12].
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A 73-year-old man presented to our hospital 5 months after a porcine replacement of an aortic valve with persistent fevers, meningoencephalopathy, and progressive renal failure; evidence of systemic emboli was found subsequently. The results of an exhaustive evaluation were negative except for two of 23 blood cultures that were performed; each of these two cultures yielded one colony of Drechslera species (now known as Bipolaris) on one plate. Autopsy revealed a fungal vegetation (9.5 x 3.2 x 3.0 cm) in the ascending aorta that arose from suture material 1.0 cm distal to the aortic valve. Mycologic evaluation of the isolate revealed that it was Bipolaris spicifera.