Ruptured Carotid Mycotic Pseudoaneurysm After Simple Carotid Endarterectomy: Case Report and Brief Literature Review

Abstract

Carotid pseudoaneurysm is an uncommon but serious complication of carotid endarterectomy. A case is presented in which the lesion occurred four weeks after combined aortocoronary bypass and carotid endarterectomy without patch angioplasty. The English surgical literature concerning this lesion is reviewed and reported. Case ReportA seventy-one-year-old diabetic white male presented to Riverside Methodist Hospitals on August 5, 1985, with claudication. A loud left carotid bruit was appreciated. Arteriography demonstrated greater than 90 % stenosis of the left internal carotid artery (ICA) at its origin (Figures 1, 2) . The vessel was not aneurysmal. The right vertebral artery was occluded, but the carotid system was normal. Aortoiliac occlusive disease, including bilateral superficial femoral artery occlusions with good runoff, was demonstrated. Cardiac catheterization was performed after resting electrocardiography had demonstrated a remote inferior wall myocardial infarction, along with nonspecific ST changes. This showed a large circumflex lesion, nondominant RCA, and 60% LAD lesion. In view of his previous silent infarction he was judged a candidate for aortocoronary bypass and left carotid endarterectomy to precede repair of his aortoiliac and lower extremity disease.On August 12, 1985, the patient underwent left carotid endarterectomy followed by aortocoronary bypass. Findings included excellent left ICA backflow, although there was severe stenosis rather high in the internal carotid that prevented placement of a shunt distally. The at Monash University on June 22, 2015 ves.sagepub.com Downloaded from

Pseudomonas aeruginosa Causing a Right Carotid Artery Mycotic Aneurysm After a Dental Extraction Procedure

“…Nine of the 15 postsurgical reports highlight the importance of carotid endarterectomy as an underlying cause. 19,[24][25][26][27][28][29][30] Graver and Mulcare 27 performed a comprehensive review of postendarterectomy pseudoaneurysms, but only 6 of 50 cases involved infection. Dougherty et al 28 found that 1% to 3% of endarterectomy grafts were complicated by infection.…”