Infectious complications of percutaneous vascular closure devices

OBJECTIVE: To describe the infectious complications of percutaneous vascular closure devices (PVCDs) on the basis of our institutional experience with PVCDs and the published medical literature. PATIENTS AND METHODS: We retrospectively reviewed all cases of PVCD-related Infection seen at the Mayo Clinic in Rochester, Mlnn, between January 1, 2000, and December 31, 2003, and searched the English language medical literature for all previously published reports. RESULTS: We identified 46 cases in the medical literature and 6 cases from our institutional database. The median age of patients was 63 years (range, 40-79 years). Diabetes mellitus and obesity were the most common comorbidlties. The median incubation period from device insertion to presentation with access-site infection was 8 days (range, 2-29 days). The most common presenting symptoms were pain, erythema, fever, swelling, and purulent drainage at the access site. Mycotic pseudoaneurysm (22 cases) was the most common complication. Staphylococcus aureus was responsible for most (75%) of the Infections. All patients underwent surgical débrldement, and 54% required reconstructive procedures. The median duration of antibiotic treatment was 28 days (range, 7-42 days). The mortality rate was 6% (3 patients). CONCLUSIONS: Infection associated with PVCD placement is uncommon but is an extremely serious complication. Morbidity is high, and aggressive medical and surgical interventions are required to achieve cure.