Management of the Infected Carotid Artery Patch



Management of the Infected Carotid Artery Patch



A. Ross Naylor


It is likely that everyone performing carotid endarterectomy (CEA) is aware of prosthetic patch infection, but only 123 cases have been reported in the world literature from 29 published series (18 of which reported a single case). Accordingly, because surgeons only tend to publish good outcomes, it is likely that the procedural risks and longer-term rates of reinfection (or other adverse outcomes) may be considerably underestimated. This should be borne in mind when interpreting discussions on this subject.


The majority of vascular surgeons use patches either selectively or routinely, and many prefer to use prosthetic patches because they are accessible and because using them avoids groin wound complications and retains the long saphenous vein for future use. Unfortunately, prosthetic carotid patches are vulnerable to infection. The true prevalence of patch infection is unknown, but it is likely to be 1% or less.




Clinical Presentation


There was a biomodal pattern of symptoms in the 123 patients with patch infection (Table 1). Thirty-six patients (29%) presented within 2 months of their primary CEA, and 78 (63%) presented after 6 months or more had elapsed. Patients presenting within 2 months were more likely to present with an abscess or complex wound infection (20/36, 56%) or patch rupture (6/36, 17%). A minority presented with false aneurysm formation (3/36, 8%). By contrast, patients presenting after more than 6 months had elapsed since their CEA were significantly more likely to present with false aneurysm (22/78, 28%) or chronic sinus discharge (28/78, 36%) and were unlikely to present with either a wound abscess (12/78, 15%) or patch rupture (6/78, 8%). Overall, only four of the 123 patients (3%) presented with either a transient ischemic attack (TIA) or stroke.




Relationship with Perioperative Infection


It is usually accepted that most prosthetic infections begin at the time of surgery. In the review of 123 cases, it was possible to correlate timing of onset of symptoms with the presence or absence of wound complications in the perioperative period in the majority of patients (Table 2). No information was provided in 46 patients. Out of the remaining 77, 32 (42%) reported either a wound infection or hematoma in the perioperative period. However, the prevalence varied according to the delay to presentation, with 26 of 31 (84%) and 3 of 7 (43%) of patients presenting at less than 2 months or 2 to 6 months (respectively), having documented evidence of a wound complication in the perioperative period compared with only 3 of 39 (8%) patients presenting late.


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Aug 25, 2016 | Posted by in CARDIOLOGY | Comments Off on Management of the Infected Carotid Artery Patch

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