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Recurrent pseudoaneurysm after carotid endarterectomy
Vitali Azouz1, Joseph N Fahmy2, Craig Kornbau1
1Department of Surgery, Summa Health, Akron, Ohio.
Abstract:
Pseudoaneurysms and patch infections are known complications of carotid endarterectomy with patch angioplasty. Although they are rare occurrences, they carry high morbidity and almost uniformly require surgical intervention. Infectious pathogens are often gram-positive bacteria, most commonly Staphylococcus species, whereas gram-negative infections are less frequently observed. We present a case of recurrent pseudoaneurysm in a patient who had a carotid endarterectomy with bovine pericardial patch angioplasty complicated by Pasteurella multocida infection. This case demonstrates the need for recognition and consideration of a broad differential of pathogens in evaluating and treating vascular infections.
Insights
Carotid endarterectomy complications like pseudoaneurysms can be caused by rare gram-negative bacteria. This case highlights the importance of considering diverse pathogens in vascular infections.
Area of Science:
- Vascular Surgery
- Infectious Diseases
- Microbiology
Background:
- Carotid endarterectomy with patch angioplasty is a procedure to prevent stroke.
- Pseudoaneurysms and patch infections are rare but serious complications.
- Commonly, these infections involve gram-positive bacteria like Staphylococcus.
Observation:
- A patient developed a recurrent pseudoaneurysm after carotid endarterectomy with a bovine pericardial patch.
- The infection was caused by Pasteurella multocida, a gram-negative bacterium.
- This contrasts with the more typical gram-positive pathogens observed in similar cases.
Findings:
- Pasteurella multocida can cause vascular graft infections, specifically pseudoaneurysms.
- Recurrent pseudoaneurysm formation indicates a challenging infection scenario.
- The bovine pericardial patch may have specific susceptibility or interaction with this pathogen.
Implications:
- Clinicians should consider a broader range of pathogens, including gram-negative bacteria like Pasteurella multocida, when diagnosing vascular infections post-procedure.
- Prompt recognition and appropriate antibiotic therapy are crucial for managing these rare but severe complications.
- Further research may be needed to understand the specific risk factors and optimal treatment strategies for Pasteurella multocida in vascular surgery patients.
