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Prosthetic patch infection after carotid endarterectomy
A R Naylor1, D Payne, N J M London
1Department of Vascular Surgery, Leicester Royal Infirmary, Leicester, UK.
Objectives And Design:
prospective audit of the management and outcome of prosthetic patch infection after carotid endarterectomy (CEA) at Leicester Royal Infirmary plus review of the literature.
Results:
8/936 CEA patients (0.85%) developed a prosthetic patch infection. Responsible organisms included MRSA (n=3), Staphylococcus epidermidis(n=2), haemolytic Streptococcus (n=1), Staphylococcus aureus(n=1) and Pseudomonas (n=1). Early wound complications preceded 4/5 infections presenting within 9 weeks of surgery. In addition to systemic antibiotics and debridement, management included patch removal and: (i) carotid ligation (n=3), vein patch repair (n=1), vein bypass (n=3). One patient had antibiotic irrigation of the in-situpatch. No patient died, one suffered a disabling postoperative stroke and two had temporary cranial nerve injuries. Including this series, a literature review identified 43 prosthetic patch infections, 91% culturing Staphylococci or Streptococci. Cumulative freedom from perioperative stroke/death or re-infection was 65% at 2 years. Patients treated by patch excision and autologous venous reconstruction had the best outcome with a cumulative freedom from perioperative stroke/death or re-infection of 91% at 2 years.
Conclusion:
prosthetic patch infection after CEA is rare. This study emphasises the importance of close surveillance of early wound complications. Surgical decision-making, especially the safety of carotid ligation, was facilitated by access to transcranial Doppler.
Insights
Prosthetic patch infection after carotid endarterectomy (CEA) is rare, occurring in 0.85% of cases. Prompt management, including patch removal and reconstruction, is crucial for optimal outcomes and preventing complications like stroke.
Area of Science:
- Vascular Surgery
- Infectious Disease
- Surgical Outcomes
Background:
- Prosthetic patches are used in carotid endarterectomy (CEA) to reduce restenosis.
- Patch infection is a rare but serious complication following CEA.
- Understanding management strategies and outcomes is vital for patient care.
Purpose of the Study:
- To audit the management and outcomes of prosthetic patch infections after CEA.
- To review the existing literature on prosthetic patch infections post-CEA.
- To identify factors influencing patient outcomes.
Main Methods:
- Prospective audit of prosthetic patch infections at Leicester Royal Infirmary.
- Literature review of 43 identified cases of prosthetic patch infections.
- Analysis of causative organisms, management strategies, and patient outcomes.
Main Results:
- Prosthetic patch infection occurred in 0.85% of 936 CEA patients.
- Common organisms included MRSA, Staphylococcus epidermidis, and Staphylococcus aureus.
- Management involved patch removal, antibiotics, and surgical reconstruction (ligation, vein patch, or bypass).
- Autologous venous reconstruction yielded the best outcomes (91% freedom from stroke/death/re-infection at 2 years).
Conclusions:
- Prosthetic patch infection after CEA is infrequent.
- Close surveillance for early wound complications is essential.
- Surgical decisions, such as carotid ligation, benefit from intraoperative monitoring like transcranial Doppler.