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Management of prosthetic patch infection after CEA
1Department of Vascular Surgery, Leicester Royal Infirmary, Leicester, UK - ross.naylor@uhl-tr.nhs.uk.
The Journal of Cardiovascular Surgery
|December 5, 2015
Summary
Prosthetic patch infections after carotid endarterectomy occur in 0.5-1% of patients, often presenting late. The gold standard treatment involves patch excision and autologous reconstruction, avoiding prosthetic materials.
Area of Science:
- Vascular Surgery
- Infectious Disease
Background:
- Carotid endarterectomy (CEA) with prosthetic patch closure has a 0.5-1% infection rate.
- Infections manifest early (wound/abscess) or late (sinus discharge/false aneurysm).
- Staphylococci/Streptococci are the most common pathogens (90%).
Purpose of the Study:
- To review the presentation, diagnosis, and management of prosthetic patch infections following CEA.
- To emphasize optimal treatment strategies and surgical considerations.
Main Methods:
- Review of reported cases and clinical presentations.
- Discussion of diagnostic considerations and treatment options.
- Emphasis on surgical planning and patient selection.
Main Results:
- Infections can occur within 2 months or after 6 months post-surgery.
- Patch rupture is rare (10%), allowing for elective management.
- Autologous reconstruction is the preferred treatment over prosthetic reconstruction.
Conclusions:
- Prompt evaluation and transfer to a tertiary center are crucial for complex cases.
- Experienced surgeons are essential for managing these complications.
- Patch excision with autologous reconstruction is the current gold standard for prosthetic patch infection treatment.
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