Management of patch infections after carotid endarterectomy and utility of femoral vein interposition bypass graft

Fatima, Javairiah; Federico, Vincent P.; Scali, Salvatore T.; Feezor, Robert J.; Berceli, Scott A.; Giles, Kristina A.; Arnaoutakis, Dean J.; Back, Martin R.; Upchurch, Gilbert R.; Huber, Thomas S.

doi:10.1016/j.jvs.2018.09.036

Cited by 15 publications

(12 citation statements)

References 20 publications

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“…In 37 patients, reconstruction with an autologous vein patch after patch excision was performed (10,12,(14)(15)(16)18,19,21,22,36,37), resulting in one reinfection, one ischemic stroke, and one infectionrelated death (all 2.7%). Patch excision followed by interposition with autologous vein was done in 69 patients (9)(10)(11)(12)(13)(15)(16)(17)(18)(19)21,23,24,27,28,31,33,38). One reinfection (1.4%), six ischemic strokes (8.7%), and two infectionrelated deaths (2.9%) were reported in this subgroup.…”

Section: Open Surgerymentioning

confidence: 99%

“…Additionally, sternocleidomastoid muscle (SCM) coverage was performed in 14 patients (17,18,20,25,32,34,35,37). Six patients had a coverage with the pectoralis major muscle (PM) (13,17,21). Muscle coverage was applied additional to several treatments, including drainage, endovascular approach, primary repair, carotid ligation, autologous vein patching, autologous artery and vein graft, and carotidcarotid bypass with venous conduit.…”

Section: Adjunctive Treatmentmentioning

confidence: 99%

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Treatment of patch infection after carotid endarterectomy: a systematic review

Wikkeling¹,

Gijssel²,

Laan³

et al. 2021

Ann Transl Med

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Carotid endarterectomy (CEA) with patch angioplasty is a widely used method for treating carotid artery stenosis. Patch infections are extremely rare, but the consequences may be serious. The current gold standard for treatment is patch excision and reconstruction with autologous material. However, no consensus has been reached and other options may be valuable as well in certain cases. The objective of this study was to evaluate the various treatment options for carotid patch infection after CEA with patch angioplasty on the basis of their outcomes (reinfection, ischemic stroke, and infection-related mortality). This systematic review was conducted in accordance with the PRISMA statement. The electronic bibliographic databases PubMed, Cochrane, and EMBASE were searched. Case series and case reports were included. Studies in languages other than English were excluded. Patients who developed a post-operative patch infection of CEA with patch angioplasty were included. Angioplasty could be performed with any type of patch. Patch infection needed to be confirmed by clinical presentation in combination with imaging, culture, or during the operation. The primary outcome measures were reinfection, ischemic stroke, and infection-related mortality. Eleven retrospective case series, two prospective case series, and seventeen case reports were included. The study size was 165 patients (mean age 69.7 years, M/F ratio 1.75:1). 171 patches developed a patch infection after CEA with patch angioplasty and needed treatment. Treatment strategies included conservative treatment (14.0%), endovascular treatment (4.7%), and open surgery (81.4%). Mean follow-up was 34.8 months and extended up to 180 months. Reinfection rate was 4.7%, ischemic stroke rate 5.8%, and infection-related mortality rate 2.3%. No statistical comparison between treatment options could be performed, because of the heterogeneity of the included studies. Autologous material should be the primary choice of treatment if patch infection is diagnosed after CEA with patch angioplasty. In emergency situations, endovascular treatment, carotid ligation, or abscess drainage could be considered. Endovascular treatment and abscess drainage are temporary solutions. After the patient has recovered sufficiently, a more durable treatment i.e., open surgery is advised. Endo vacuum assisted closure (EndoVAC) seems to be promising. Further research is needed to determine the applicability of each treatment option.

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Section: Open Surgerymentioning

confidence: 99%

Section: Adjunctive Treatmentmentioning

confidence: 99%

Treatment of patch infection after carotid endarterectomy: a systematic review

Wikkeling¹,

Gijssel²,

Laan³

et al. 2021

Ann Transl Med

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“…Perioperative stroke is the second most common cause of death in carotid endarterectomy [25,26,28,32,33,35,36] with a rate of less than 3% for symptomatic patients and less than 5% for the symptomatic patients depending on the indication of the CEA and the experience of the surgeon. But also there are some factors that can contribute to postoperative stroke [28,[37][38][39][40][41][42] like plaque emboli, platelet aggregates, improper flushing, poor cerebral protection, and relative hypotension.…”

Section: Perioperative Strokementioning

confidence: 99%

“…Hypoglossal nerve is the most frequently injurie manifested by a deviation of the tongue to the side of the injury, the facial nerve is the second one resulting in paresis of the lateral aspect of the orbicularis oris muscle with asymmetric smile; and the vagus nerve which result in unilateral vocal cord paralysis, glossopharyngeal nerve can be damaged with excessive dissection in the carotid bifurcation [26,32,36].…”

Section: Nerve Injurymentioning

confidence: 99%

“…Clinically the patient will have neck swelling and drainage from incision in acute events; in delayed infections, a draining sinus tract or pulsatile neck mass could be indicative of a carotid pseudoaneurysm. If infection persists, a patch excision is indicated with early carotid ligation, reconstruction with autogenous vein, or bypass; nowadays the use of negative pressure systems is a good option to perform a better treatment of these infections, resulting in better outcomes and reducing complications of a new exploratory surgery in these patients [3,13,19,[25][26][27][28][29][30][31][32][33][34][35][36][37][38][39][40][41].…”

Section: Infectionmentioning

confidence: 99%

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Carotid Disease

Rejón¹,

Robles²

2020

Atherosclerosis, Arteriosclerosis and Arteriolosclerosis

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Atherosclerotic carotid disease causes about 30% of cerebrovascular ischemia transitory or permanent in the world; the severity of symptoms is variable. The clinical manifestations are varied from focal neurological alterations to transient or permanent vascular events. The treatment of the disease will depend on the location, degree, and risk, which can be surgical, endovascular, or medical. Open surgical treatment, endarterectomy, has been preferred as the first option and, however, has been reported to have associated complications like infection, hematoma, stroke, heart attack, restenosis, etc. With the advent of new technologies, endovascular treatment has been described as an option in patients with high risk or restenosis.

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