Successful management of mycotic anastomotic pseudoaneurysm of interposition vein graft following a carotid endarterectomy: a case report.
Anastomotic pseudoaneurysm
Carotid endarterectomy
Extra-anatomical bypass
Journal
Journal of medical case reports
ISSN: 1752-1947
Titre abrégé: J Med Case Rep
Pays: England
ID NLM: 101293382
Informations de publication
Date de publication:
31 Oct 2024
31 Oct 2024
Historique:
received:
13
06
2024
accepted:
14
09
2024
medline:
31
10
2024
pubmed:
31
10
2024
entrez:
31
10
2024
Statut:
epublish
Résumé
Anastomotic pseudoaneurysms of interposition vein grafts are a rare entity that requires urgent management to prevent life-threatening complications, such as rupture and thromboembolism, especially when involving the carotid arteries. As these are rare complications and literature is sparse, we believe that this case report can aid the decision-making process in similar circumstances. A 49-year-old Ukrainian male patient presented with a false aneurysm of both distal and proximal anastomosis of an interposition vein graft between the common carotid artery and the internal carotid artery, which was previously performed as a bailout procedure after the patient developed a complication of carotid surgery. The patient was successfully treated with extra-anatomical interposition of a vein graft from the subclavian artery to the remnant of extracranial internal carotid artery and en bloc excision of the previous vein graft with the false aneurysms. Mycotic anastomotic pseudoaneurysms following carotid endarterectomy represent a rare yet serious complication in vascular surgery that requires urgent treatment. While endovascular techniques could represent an alternative option, open surgical repair is still the standard of care for this pathology, offering advantages in preventing postoperative ischemic complications and ensuring optimal long-term outcomes. The open approach provides direct visualization of the pseudoaneurysm. It allows the meticulous debridement of the infected tissues and an accurate reconstruction of the arterial wall with autologous or synthetic grafts. In light of the substantial evidence supporting its superiority, open surgical repair should remain the preferred approach in addressing mycotic anastomotic pseudoaneurysms following carotid endarterectomy. Future research should continue to explore advancements in other surgical techniques and refine treatment strategies to enhance patient outcomes in this challenging clinical scenario.
Sections du résumé
BACKGROUND
BACKGROUND
Anastomotic pseudoaneurysms of interposition vein grafts are a rare entity that requires urgent management to prevent life-threatening complications, such as rupture and thromboembolism, especially when involving the carotid arteries. As these are rare complications and literature is sparse, we believe that this case report can aid the decision-making process in similar circumstances.
CASE PRESENTATION
METHODS
A 49-year-old Ukrainian male patient presented with a false aneurysm of both distal and proximal anastomosis of an interposition vein graft between the common carotid artery and the internal carotid artery, which was previously performed as a bailout procedure after the patient developed a complication of carotid surgery. The patient was successfully treated with extra-anatomical interposition of a vein graft from the subclavian artery to the remnant of extracranial internal carotid artery and en bloc excision of the previous vein graft with the false aneurysms.
CONCLUSION
CONCLUSIONS
Mycotic anastomotic pseudoaneurysms following carotid endarterectomy represent a rare yet serious complication in vascular surgery that requires urgent treatment. While endovascular techniques could represent an alternative option, open surgical repair is still the standard of care for this pathology, offering advantages in preventing postoperative ischemic complications and ensuring optimal long-term outcomes. The open approach provides direct visualization of the pseudoaneurysm. It allows the meticulous debridement of the infected tissues and an accurate reconstruction of the arterial wall with autologous or synthetic grafts. In light of the substantial evidence supporting its superiority, open surgical repair should remain the preferred approach in addressing mycotic anastomotic pseudoaneurysms following carotid endarterectomy. Future research should continue to explore advancements in other surgical techniques and refine treatment strategies to enhance patient outcomes in this challenging clinical scenario.
Identifiants
pubmed: 39478618
doi: 10.1186/s13256-024-04874-9
pii: 10.1186/s13256-024-04874-9
doi:
Types de publication
Case Reports
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
531Informations de copyright
© 2024. The Author(s).
Références
Marković DM, Davidović LB, Kostić DM, Maksimović ZV, Cinara IS, Cvetković SD, Marković MD, Dragas MV. Anastomotic pseudoaneurysms. Srp Arh Celok Lek. 2006;134(3–4):114–21. https://doi.org/10.2298/sarh0604114m .
doi: 10.2298/sarh0604114m
pubmed: 16915751
Silveira D, Martins J, Pereira C, Pereira M do SC, Almeida R. Renal allograft anastomotic pseudoaneurysm presenting with acute renal failure: a case of surgical treatment with graft preservation. Angiologia e Cirurgia Vascular. 2015;11(3):177–181. https://doi.org/10.1016/j.ancv.2015.05.004 .
Heskett C, Brake A, Fry L, De Stefano FA, Lei C, Chatley K, Peterson J, Ebersole K. Treatment options for pseudoaneurysm after carotid endarterectomy: a systematic review and illustrative case. World Neurosurg. 2022;167:131–46. https://doi.org/10.1016/j.wneu.2022.08.124 .
doi: 10.1016/j.wneu.2022.08.124
pubmed: 36058488
El-Sabrout R, Reul G, Cooley DA. Infected postcarotid endarterectomy pseudoaneurysms: retrospective review of a series. Ann Vasc Surg. 2000;14(3):239–47. https://doi.org/10.1007/s100169910041 .
doi: 10.1007/s100169910041
pubmed: 10796955
Adlouni M, Koh EY, Rahimi M. Managing an infected femoral artery pseudoaneurysm after thoraco-bifemoral bypass with an innovative configuration. J Vasc Surg Cases Innov Tech. 2022;8(4):583–6. https://doi.org/10.1016/j.jvscit.2022.08.023 .
doi: 10.1016/j.jvscit.2022.08.023
pubmed: 36248387
pmcid: 9556622
Ahuja V, Tefera G. Successful covered stent-graft exclusion of carotid artery pseudo-aneurysm: two case reports and review of literature. Ann Vasc Surg. 2007;21(3):367–72. https://doi.org/10.1016/j.avsg.2006.06.015 .
doi: 10.1016/j.avsg.2006.06.015
pubmed: 17484973
Ocal O, Yilmaz M, Peynircioglu B, Bilginer B, Peker A, Arat A. Hybrid vascular intervention for a giant cervical carotid artery aneurysm in a clopidogrel-hyporesponsive child. J Neurosurg Pediatr. 2018;22(3):265–9. https://doi.org/10.3171/2018.3.PEDS17669 .
doi: 10.3171/2018.3.PEDS17669
pubmed: 29932366
Davidovic L, Koncar I, Dragas M, Ilic N, Banzic I, Pavlovic SU, Markovic M, Ristanovic N. Treatment strategies for carotid artery aneurysms. J Cardiovasc Surg (Torino). 2016;57(6):872–80.
pubmed: 24866774
Baril DT, Ellozy SH, Carroccio A, Patel AB, Lookstein RA, Marin ML. Endovascular repair of an infected carotid artery pseudoaneurysm. J Vasc Surg. 2004;40(5):1024–7. https://doi.org/10.1016/j.jvs.2004.08.019 .
doi: 10.1016/j.jvs.2004.08.019
pubmed: 15557920