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Our report encompasses two cases of Dacron patch infection following carotid endarterectomy and a systematic review of the literature. Particular attention is placed on the incidence, aetiology, investigation, presentation and management dilemmas of this rare complication of carotid surgery. We present all known cases of synthetic patch infection following carotid endarterectomy over the last 12 years. 14 publications have been identified totalling 77 cases of graft infection. Approximately 0.25-0.5% of all Dacron patches appear to get infected. Infection may present early or late and appears to have a bi-modal distribution depending on the presence of low- or high-grade infection. Post-operative complications especially wound haematoma is associated with the later development of infection. Most patients present with pseudoaneurysm formation, neck swelling or a draining local sinus and are infected with either Staphylococcus epidermidis or Staphylococcus aureus. Duplex ultrasound is the investigation of choice and complete excision of all infected material and arterial reconstruction with a vein patch or graft is recommended. Dacron patch infection is a rare but recognised complication of carotid surgery and knowledge of this condition is vital for vascular surgeons and other speciality surgeons to whom cases may present.

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We report the case of a 76-year-old man of the Jehovah's Witness faith who had a giant abdominal aortoiliac aneurysm that was successfully operated on using an aortoiliac Y-graft bypass technique, without the use of stored allogenic blood. Cell saver technique and recombinant human erythropoietin (epoetin beta) were used during the perioperative period. The patient had good postoperative care with a multidisciplinary approach.