Introduction: We evaluated outcomes of closed incisional negative pressure therapy (ciNPT) on surgical site infection (SSI) rates in lower extremity bypass patients. We sought to determine whether or not the routine use of ciNPT is a cost-effective measure. Methods: During a period from May 2018 to August 2018, our institution transitioned to the routine use of ciNPT for re-vascularization procedures. We retrospectively reviewed our outcomes before and after the initiation of ciNPT. Group A included patients from September 2017 to April 2018 without ciNPT and Group B included patients from September 2018 to April 2019 with ciNPT. Chi-squared analysis was performed and the p value was set at <0.05 to obtain statistical significance. Cost analysis was separately performed utilizing hospital metrics. Results: There were a total of 102 patients in Group A and 113 patients in Group B. There was no difference in demographic information between the two groups. The overall SSI rate for Group A was 11.8% (12/102). Group B had an overall SSI rate of 3.5% (4/113; p=0.02). Deep infection rate for Group A was 7% (7/102) and for Group B was 1% (1/113; p=0.01). Cost analysis demonstrated a minimum of $62,000 in infection-related cost savings between both groups. Conclusions: ciNPT has had a profound effect on our practice and has resulted in a decrease in both deep and superficial infections. This has led to a significant cost-effective measure for our institution. We now routinely use ciNPT on all lower extremity bypass patients.

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Extracranial internal carotid artery (EICA) aneurysms make up 1% of peripheral aneurysms and less than 1% of patients who have relapsing polychondritis develop aneurysms. A 39-year-old man with relapsing polychondritis presented with right neck pain. Initial computed tomography angiography demonstrated a 16-mm right EICA aneurysm with growth to 25 mm after 2 months. A right EICA aneurysmectomy, external carotid artery to ICA transposition, and internal jugular vein patch of the common carotid artery was performed with symptom resolution. The inflammatory nature of the underlying disease, aggressive expansion, and symptomatic state warranted open repair and we recommend life-long monitoring given the rarity of this case.