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Mycotic carotid pseudoaneurysm: staged endovascular and surgical repair
L Wales1, A J Kruger, J S Jenkins
1Department of Vascular Surgery, Royal Brisbane and Women's Hospital, Queensland, Australia.
Abstract:
Mycotic carotid pseudoaneurysms are rare and challenging to manage. Traditional surgical approaches are technically demanding and can be associated with a high morbidity and mortality. The use of endovascular stents in infected fields remains controversial, and long-term efficacy has not been fully clarified. We describe a case where a combined staged endovascular and open surgical approach was used to successfully manage a mycotic carotid pseudoaneurysm that developed following dental extraction. A covered endovascular stent was used to temporarily exclude the infected pseudoaneurysm, before proceeding to early definitive surgical management. We suggest that staged endovascular therapy followed by early surgical repair should be considered for this difficult surgical problem.
Insights
Mycotic carotid pseudoaneurysms are rare. A staged endovascular and open surgical approach successfully managed a case, suggesting this combined method for difficult infections.
Area of Science:
- Vascular Surgery
- Infectious Diseases
- Interventional Radiology
Background:
- Mycotic carotid pseudoaneurysms are uncommon and difficult vascular conditions.
- Traditional open surgery carries significant risks.
- Endovascular stent use in infected areas is debated.
Observation:
- A patient developed a mycotic carotid pseudoaneurysm after dental extraction.
- A covered endovascular stent was used for temporary exclusion.
- This was followed by definitive open surgical repair.
Findings:
- A combined, staged endovascular and open surgical approach was successful.
- Temporary exclusion with a covered stent facilitated subsequent surgery.
- This strategy effectively managed the complex mycotic pseudoaneurysm.
Implications:
- Staged endovascular therapy followed by early surgical repair is a viable option.
- This approach may reduce morbidity and mortality in managing these challenging cases.
- Further research into long-term outcomes of endovascular interventions in infected fields is warranted.
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