Treatment Options for Pseudoaneurysm After Carotid Endarterectomy: A Systematic Review and Illustrative Case

Heskett, Cody; Brake, Aaron; Fry, Lane; Stefano, Frank De; Lei, Catherine; Chatley, Kevin; Peterson, Jeremy; Ebersole, Koji

doi:10.1016/j.wneu.2022.08.124

Cited by 7 publications

(4 citation statements)

References 62 publications

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“…The standard of care for treating infected carotid artery pseudoaneurysms predominantly involves traditional open repair. This approach includes aneurysmectomy, debridement of surrounding infected tissues, and carotid artery ligation (32)(33)(34)(35). Revascularization of the ICA is generally considered only in cases where it is deemed essential, such as in patients with bilateral ICA disease (36,37).…”

Section: Discussionmentioning

confidence: 99%

Lemierre's Syndrome: Atypical Presentation of the Internal Carotid Artery and Jugular Vein Fistula—CaseReport and Review

Kariuki,

Musabyemungu,

kebedi

et al. 2024

Preprint

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Background: Lemierre's syndrome (LS) is a rare yet potentially life-threatening complication of oropharyngeal infections that is typically characterized by septic thrombophlebitis of the internal jugular vein and is commonly associated with Fusobacterium necrophorum. Despite its recognition since 1936, LS can present atypically, as seen in our case where a patient exhibited a rare complication of an internal carotid artery and jugular vein fistula. This case highlights the diagnostic and therapeutic challenges that can arise and underscores the importance of both a broader awareness of LS and the necessity for a multidisciplinary approach. Case Presentation: A 42-year-old male who was initially diagnosed with a periodontal abscess and tonsillitis later developed internal jugular vein thrombophlebitis. This progressed to an internal carotid to internal jugular vein fistula, leading to septic thrombosis of the left internal carotid and jugular vein and eventually culminating in a carotid bulb aneurysm and subsequent cerebral infarct. The patient also experienced septic emboli, resulting in lung and mediastinal abscesses. Treatment involved intravenous antibiotics, anticoagulant therapy, and vascular repair, yielding a favorable outcome. Conclusions: This case underscores the intricate nature of LS, showing its potential to progress to severe septic complications, including rare vascular issues and cerebral infarction. The diagnostic complexities and therapeutic interventions emphasize the critical importance of early identification, prompt diagnosis, and multidisciplinary management of LS to prevent life-threatening outcomes.

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Section: Discussionmentioning

confidence: 99%

Lemierre's Syndrome: Atypical Presentation of the Internal Carotid Artery and Jugular Vein Fistula—CaseReport and Review

Kariuki,

Musabyemungu,

kebedi

et al. 2024

Preprint

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“…A systematic review conducted by Heskett et al . revealed that open surgery exhibited an almost 30% rate of procedure-related complications [ 11 ]. In recent years, with advancements in interventional techniques and materials, endovascular treatment has emerged as an effective modality for addressing pseudoaneurysms post-CEA, particularly in cases of noninfectious pseudoaneurysms.…”

Section: Discussionmentioning

confidence: 99%

Successful treatment of iatrogenic internal carotid artery pseudoaneurysm following carotid endarterectomy with thrombin injection: a case report

Jiang,

Liu,

Zhuo

et al. 2024

J Med Case Reports

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Background Iatrogenic pseudoaneurysms arising from the internal carotid artery subsequent to carotid endarterectomy are exceptionally infrequent. Herein, we present a case detailing an internal carotid artery pseudoaneurysm that manifested subsequent to a hybrid carotid endarterectomy and endovascular therapy intervention. Our approach to managing this condition involved a novel technique wherein thrombin was directly injected into the luminal cavity of the pseudoaneurysm under the guidance of a C-arm. Case presentation A 66-year-old male patient of Chinese ethnicity exhibited a 4-month history of headache and a 20-day history of gait disturbance. Digital subtraction angiography revealed occlusion in the cervical region of the left carotid artery. Following a hybrid surgical procedure, the patient reported mild pain and bruising surrounding the incision site of the left internal carotid artery endarterectomy. Subsequent angiography identified the presence of a carotid artery pseudoaneurysm. Utilizing C-arm guidance, thrombin was then directly injected into the luminal cavity of the pseudoaneurysm, resulting in complete healing during follow-up. Conclusion For the management of pseudoaneurysms arising post carotid endarterectomy, the direct injection of thrombin into the aneurysm cavity under the guidance of a C-arm is deemed both safe and efficacious.

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“…While most microembolization may be asymptomatic, they may also give rise to neurological events and cognitive impairment [ 123 ]. Post-endarterectomy pseudoaneurysm (PEPA) or pseudoaneurysm formation following CEA is an infrequent occurrence, accounting only for 0.3%-0.6% of all procedures [ 124 , 125 ]. PAs after CEA is not limited to the immediate postoperative period since evidence indicates that their development could take place several years after the initial CEA operation [ 126 ].…”

Section: Reviewmentioning

confidence: 99%

Carotid Artery Stenosis: A Look Into the Diagnostic and Management Strategies, and Related Complications

Ismail¹,

Ravipati²,

Gonzalez‐Hernandez³

et al. 2023

Cureus

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Carotid stenosis (CS) is a buildup of atherosclerotic plaque within the artery leading to a wide range of symptoms, from mild symptoms, including blurred vision and confusion, to much more life-threatening presentations, including paralysis due to stroke. The presentation is insidious, with symptoms exhibiting predominantly at severe stenosis; hence the emphasis is placed on the importance of early diagnosis, treatment, and lifestyle modifications. CS is seen undergoing almost the same pathogenesis of any atherosclerotic plaque formation, from endothelial damage of the artery lumen to the formation of a fibrous cap with a foam cell, lipid-filled core. The findings of our review article were consistent with the recent literature, depicting that comorbid hypertension, diabetes, and chronic kidney disease (CKD), and lifestyle aspects, including smoking and diet, played the most salient role in plaque development. Among several imaging modalities, duplex ultrasound (DUS) imaging is the widely preferred method in clinical practice. Carotid endarterectomy (CEA) and carotid stenting are the primarily advocated procedures for symptomatic severe stenosis, with similar long-term outcomes. Although, earlier clinical trials showed promising results in mitigating the risk of stroke among asymptomatic severe CS with surgical intervention. However, recent advancements have shifted the focus to medical management alone due to comparable results among the asymptomatic population. Both surgical and medical regimens are beneficial in treating patients, but it is still an ongoing debate as to which is predominantly superior. The currently advancing trials and research will help elucidate definitive guidelines. However, the massive impact of lifestyle modifications advocates some degree of individualized multidisciplinary management strategies.

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Treatment Options for Pseudoaneurysm After Carotid Endarterectomy: A Systematic Review and Illustrative Case

Cited by 7 publications

References 62 publications

Lemierre's Syndrome: Atypical Presentation of the Internal Carotid Artery and Jugular Vein Fistula—CaseReport and Review

Lemierre's Syndrome: Atypical Presentation of the Internal Carotid Artery and Jugular Vein Fistula—CaseReport and Review

Successful treatment of iatrogenic internal carotid artery pseudoaneurysm following carotid endarterectomy with thrombin injection: a case report

Carotid Artery Stenosis: A Look Into the Diagnostic and Management Strategies, and Related Complications

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