Pseudoaneurysms occur postoperatively with an incidence of 0.5- 1.5 %
and infection is thought to be a major cause with Staphylococcus
epidermidis or Staphylococcus aureus as the most common organism
implicated. (6) The risk of rupture, embolization, or compression of
cranial nerves means that prompt intervention is advised. Presentation
is bimodal with the majority presenting either before 2 months or after
6 months with cases reported up to 20 years postoperatively. (7) (8)
Unlike previously reported cases, our case had a known occluded internal
carotid artery prior to developing a pseudoaneurysm.
The gold standard treatment is excision of pseudoaneurysm and infected
patch with interposition vein graft repair. However, carotid artery
ligation is required in up to 22.7% of cases and has an associated
death/ major stroke rate of 50%. (9) A number of alternatives to
saphenous vein grafts have been proposed. Fatima et al. reported an
acceptable outcome with their experience with femoral vein interposition
graft. (10) They demonstrated excellent patency and good long-term
survival of 82% at 5 years in their series of 24 patients treated with
femoral vein interposition graft with 7% complaining of leg swelling
and femoral nerve palsy that resolved in 3 months follow up. They
propose the femoral vein as an option in carotid size mismatch or in
limited availability. Morasch et el report their experience with
autologous superficial femoral artery and preference to use this as a
conduit. In their series of 6 patients they reverse the arterial conduit
for best size match with the carotid artery and used a Goretex
interposition graft to repair the harvested segment. Although a small
sample size, they reported high durability and low re-infection rates.
(11)
|
Pseudoaneurysms occur postoperatively with an incidence of 0.5- 1.5 %
and infection is thought to be a major cause with Staphylococcus
epidermidis or Staphylococcus aureus as the most common organism
implicated. (6) The risk of rupture, embolization, or compression of
cranial nerves means that prompt intervention is advised. Presentation
is bimodal with the majority presenting either before 2 months or after
6 months with cases reported up to 20 years postoperatively. (7) (8)
Unlike previously reported cases, our case had a known occluded internal
carotid artery prior to developing a pseudoaneurysm.
The gold standard treatment is excision of pseudoaneurysm and infected
patch with interposition vein graft repair. However, carotid artery
ligation is required in up to 22.7% of cases and has an associated
death/ major stroke rate of 50%. (9) A number of alternatives to
saphenous vein grafts have been proposed. Fatima et al. reported an
acceptable outcome with their experience with femoral vein interposition
graft. (10) They demonstrated excellent patency and good long-term
survival of 82% at 5 years in their series of 24 patients treated with
femoral vein interposition graft with 7% complaining of leg swelling
and femoral nerve palsy that resolved in 3 months follow up. They
propose the femoral vein as an option in carotid size mismatch or in
limited availability. Morasch et el report their experience with
autologous superficial femoral artery and preference to use this as a
conduit. In their series of 6 patients they reverse the arterial conduit
for best size match with the carotid artery and used a Goretex
interposition graft to repair the harvested segment. Although a small
sample size, they reported high durability and low re-infection rates.
(11)
|