Late Dacron Patch Inflammatory Reaction after Carotid Endarterectomy

Abstract

Late wound complications after CEA may be related to inflammatory reaction of the Dacron patch rather than infection. Infection should be excluded first. Reconstruction with vein is effective. However, debridement with sternomastoid and omohyoid muscle covering of the patch may be considered in high risk patients after exclusion of infection with regular follow-up.

Bioengineered human acellular vessels recellularize and evolve into living blood vessels after human implantation

“…Previous histopathological analyses of explanted vascular grafts have demonstrated that the host cell response often determines the fate of the implanted material. Commercially available synthetic grafts can provoke inflammatory reactions, fail to integrate properly into the surrounding tissue, and can inhibit host neutrophil behavior leading to sustained bacterial infections (29)(30)(31). Chemically cross-linked, sterilized, or cryopreserved allografts and xenografts have also been shown to trigger inflammatory and immune responses and fail to appropriately recellularize (32)(33)(34)(35).…”

Intestinal perforation involving the Dacron cuff of nephrostomy tubes following subcutaneous ureteral bypass system implantation for ureteral obstructions in two cats

“…15 Additionally, late Dacron patch inflammatory complications in humans has been reported up to 7 years post-implantation. 16 Therefore, secondarily, a foreign body reaction could have developed from the Dacron cuff within the abdominal cavity, contributing to the transmural migration into the small intestine.…”

Commentary on “Late Dacron Patch Inflammatory Reaction After Carotid Endarterectomy”

“…Notwithstanding this disruptive paper, the available evidence from the literature would suggest that surgical exploration along with patch excision and debridement of all infected tissue combined with autologous revascularisation, remains the gold standard for the majority of patients with suspected patch infection. As shown in the studies by Alawy et al and Mann et al, 1,2 replacement with a prosthetic patch carries a high risk of re-infection and should be avoided. The same is true for carotid ligation, which is associated with a high risk of peri-operative stroke but may be necessary in rare cases of infection with highvirulence organisms.…”

“…The same is true for carotid ligation, which is associated with a high risk of peri-operative stroke but may be necessary in rare cases of infection with highvirulence organisms. Finally, while we admit that insertion of a covered stent for a ruptured pseudoaneurysm, makes sense 1,3 , it should remain a bridge to delayed autogenous revascularisation.…”

“…It has been reported that 0.5e1% of patients undergoing carotid endarterectomy (CEA) with a prosthetic patch arteriotomy closure will develop patch infection, two thirds of them occurring after 6 months have passed, with occasionally chronic sinus discharge and false aneurysm formation, as described by Alawi et al 1 In the retrospective series by Alawi et al, 1 eight patients returned with suspected prosthetic patch infection after a period ranging from 18 months to 7 years. Among them, six patients presented with a serous wound sinus discharge and two with a pulsatile mass in the neck.…”