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Recurrent pseudoaneurysm after carotid endarterectomy
Vitali Azouz1, Joseph N Fahmy2, Craig Kornbau1
1Department of Surgery, Summa Health, Akron, Ohio.
Summary
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.
