Management challenges of late presentation Dacron patch infection after carotid endarterectomy

Xu, Jie; Altaf, Nishath; Tosenovsky, Patrik; Mwipatayi, Bibombe P.

doi:10.1136/bcr-2017-221541

Cited by 5 publications

(4 citation statements)

References 13 publications

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“…The most performed intervention in the case of carotid patch infection is complete patch removal and reconstruction. 4 This strategy is probably the gold standard for the majority of patients. Options for reconstruction include primary closure, autologous vein patch, and vein or native artery bypass.…”

Section: Discussionmentioning

confidence: 99%

“…In the literature, this option has been reported in 26 cases (20% of the patch infections). 4 Most of them were included in a single series of carotid patch infections where the authors reported the patch preservation in 17 of 25 patients. Interestingly, only one of them presented a draining sinus, whereas most of them presented more serious symptoms, even though they found similar long-term results with patch preservation and patch excision.…”

Section: Discussionmentioning

confidence: 99%

“…10 Regarding the outcomes of patch preservation, it has to be highlighted that only 3 of 26 patients reported to date suffered a re-infection. 4 Thus, it seems that successful outcomes can be achieved by excision of the infected tissue and leaving the patch intact.…”

Section: Discussionmentioning

confidence: 99%

“…To date, the prosthetic patch has been left in situ only in 26 patients. 4 We report the case of a patient with a sinus, presented 81 months after carotid endarterectomy and 60 months after carotid stenting for restenosis. The patient underwent conservative surgical treatment, with preservation of the carotid patch.…”

Section: Introductionmentioning

confidence: 99%

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Conservative Surgical Management of Late Carotid Patch Infection in a Patient with Subsequent Stenting for Restenosis

Torres-Blanco

García

Miralles-Hernández

2021

Vasc Endovascular Surg

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Carotid patch infection is a rare but dreaded complication after endarterectomy. About 160 cases can be found in literature, but presentation in a patient with post-endarterectomy stenting has not been reported. Most frequent clinical manifestations include the occurrence of a sinus, a pseudoaneurysm, or neck swelling, but in severe cases it may present anastomosis dehiscence with hematoma or hemorrhage. Usually, patch removal and reconstruction is recommended, but there is not a standard protocol for management. Conservative surgical management with patch preservation has only been reported in a minority of cases. We report a patient with a history of carotid endarterectomy and subsequent carotid stenting 21 months later because of >80% restenosis. He presented a sinus in the scar 81 months after the former intervention. The patient underwent surgery, and during the procedure, a detachment of a small segment of the Dacron patch from the surrounding tissue was found. The sinus tract was resected, and after verifying the integrity of the patch, it was irrigated with rifampicin and preserved in situ. S. epidermidis was isolated from tissue cultures. Twenty-four months later, the patient remains asymptomatic and duplex ultrasound shows no signs of infection. Conservative surgical approach can be a valid option for treatment and may be considered in selected patients with limited infection.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Conservative Surgical Management of Late Carotid Patch Infection in a Patient with Subsequent Stenting for Restenosis

Torres-Blanco

García

Miralles-Hernández

2021

Vasc Endovascular Surg

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Surgical Pitfalls in Carotid Endarterectomy: A New Step-By-Step Approach

Yalvaç

Baran

Aydın

et al. 2018

Journal of Craniofacial Surgery

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Carotid endarterectomy (CEA) is a surgical intervention that may prevent stroke in asymptomatic and symptomatic patients. Our aim was to examine the microsurgical anatomy of carotid artery and other related neurovascular structures to summarize the CEA that is currently applied in ideal conditions. The upper necks of 2 adult cadavers (4 sides) were dissected using ×3 to ×40 magnification. The common carotid artery, external carotid artery (ECA), and internal carotid artery were exposed and examined. The surgical steps of CEA were described using 3-D cadaveric photos and computed tomography angiographic pictures obtained with help of OsiriX imaging software program. Segregating certain neurovascular and muscular structures in the course of CEA significantly increased the exposure. The division of facial vein allowed for internal jugular vein to be mobilized more laterally and dividing the posterior belly of digastric muscle resulted in an additional dorsal exposure of almost 2 cm. Isolating the ansa cervicalis that pulls hypoglossal nerve inferiorly allowed hypoglossal nerve to be released safely medially. The locations of the ECA branches alter depending on their anatomical variations. The hypoglossal nerve, glossopharyngeal nerve, and accessory nerve pierce the fascia of the upper part of the carotid sheath and they are vulnerable to injury because of their distinct courses along the surgical route. Surgical exposure in CEA requires meticulous dissection and detailed knowledge of microsurgical anatomy of the neck region to avoid neurovascular injuries and to determine the necessary surgical maneuvers in cases with neurovascular variations.

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