Septic Carotid Endarterectomy Patch as a Result of Preoperative Tooth Extraction

Infected carotid patches are rare. We present a gentleman who had an elective carotid endarterectomy with Dacron patch closure for symptomatic carotid stenosis under regional anesthesia, and he presented 1 month later with a discharging sinus at the lower aspect of the neck wound. Computed tomography scan showed a rim-enhancing collection next to the carotid bifurcation. He subsequently underwent patch excision and repair with autologous saphenous vein graft, with good recovery. Of significance was that he had a dental extraction for a loose tooth 1 day before the index operation as advised by the anesthetist. Streptococcus viridans species, which are part of the normal flora of oral cavity, were isolated from the tissue culture. This is the first case in the world's literature of a patient who had S. viridans carotid patch infection that may be related to his preoperative tooth extraction.