Vein reconstruction of a mycotic internal carotid aneurysm

Carotid aneurysms are an extremely rare entity; mycotic carotid aneurysms are even more uncommon. Most articles in the past have advocated ligation as treatment of mycotic carotid aneurysms due to the dangers of graft placement in an infected field. Unfortunately, stroke occurs in many patients so treated. As the cerebral complications were so high, bypass using autogenous vein and fine monofilament polypropylene sutures is attractive. This technique was used in a patient having a mycotic carotid aneurysm who was referred to the Vascular Service of the Shands Teaching Hospital. Pre- and postoperative antibiotics, resection of the aneurysm, anastomosis in a noninfected area, and long-term oral antibiotics were felt to be other important aspects of the patient's treatment. This individual is well one year after operation without neurological sequelae. This case suggests that if strict operative and therapeutic guidelines are observed, bypass with autogenous vein is a feasible operative alternative in patients having mycotic carotid aneurysms. The risk of this procedure must be carefully weighed against the devastating neurological sequellae that might result with ligation.