[Infectious complications of reconstructive operations on carotid arteries in atherosclerotic stenoses]

Analysed herein are the outcomes of a total of 2,240 reconstructive operations on carotid arteries (CA) performed in patients presenting with CA stenosis. Twenty-two (0.98%) patients were found to have developed infectious complications with the involvement of the reconstructed zone. Once suppuration had occurred sixteen patients were subjected to autovenous prosthetic repair of the internal carotid artery (ICA), with a further four cases having endured prosthetic reconstruction with a portion of the external CA, and the remaining two patients sustained ligation of the ICA. In the immediate postoperative period, two deaths had occurred, with recurrent infections accompanied and followed by the development of arrosive haemorrhage observed in two cases. The most commonly encountered microbial agents responsible for suppuration were largely staphylococci and streptococci, as well as Escherichia coli. The preoperative and postoperative prevention with antibiotics is obligatory. In order to assess the condition of the carotid arteries and involvement thereof into the infectious process it is necessary to rely upon the findings of ultrasonographic scanning of soft tissues of the neck in a combination with duplex scanning of carotid arteries. Early aggressive surgical policy consisting in extended surgical debridement of the infectious wound, reconstruction of the CA with autologous tissue aimed at preserving cerebral blood supply, and targeted antibiotic therapy make it possible in the majority of cases to obtain positive therapeutic outcomes.