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[Cervical epidural anesthesia for carotid mycotic aneurysms]
A Llorente1, E Bronte, G Ramos
1Servicio de Anestesiología y Reanimación, Complejo Hospitalario de León.
Abstract:
Extracranial mycotic aneurysms of the carotid are unusual. We present such an aneurysm of the right primary carotid caused by enteritis due to Salmonella in a 75-year-old patient at high risk for surgery (myocardial ischemia evolving over 3 months) and with coexisting stenosis of 75% of the left internal carotid. Endarterectomy of the left internal carotid, with shunting, was performed, after which the right primary carotid was tied during the same operation. Epidural anesthesia to C6-C7 was provided through a catheter supplemented with an intravenous propofol infusion. Neurological and hemodynamic variables monitored during surgery were stable. No neurological deficits or myocardial ischemic changes were recorded. Three months after discharge the patient was asymptomatic.
Insights
A rare Salmonella-induced carotid artery aneurysm was successfully treated in a high-risk patient. Surgical intervention, including endarterectomy and carotid ligation, resulted in a positive outcome with no complications.
Area of Science:
- Vascular Surgery
- Infectious Diseases
- Cardiology
Background:
- Extracranial mycotic aneurysms of the carotid artery are rare vascular conditions.
- Salmonella enteritis can lead to serious complications, including aneurysms.
- Managing patients with complex comorbidities, such as myocardial ischemia and carotid stenosis, presents significant surgical challenges.
Observation:
- A 75-year-old patient with a history of myocardial ischemia and severe left internal carotid artery stenosis presented with a right primary carotid artery mycotic aneurysm.
- The aneurysm was attributed to Salmonella enteritis.
- The patient was deemed high-risk for conventional surgical approaches.
Findings:
- A simultaneous surgical procedure was performed, involving endarterectomy of the left internal carotid artery with shunting and ligation of the right primary carotid artery.
- Epidural anesthesia supplemented with propofol infusion was utilized.
- Neurological and hemodynamic monitoring revealed stable intraoperative conditions.
- The patient experienced no neurological deficits or myocardial ischemic events post-operatively.
Implications:
- This case demonstrates a successful and innovative surgical strategy for managing complex extracranial mycotic carotid aneurysms in high-risk patients.
- The combined approach of endarterectomy and carotid ligation, under specialized anesthesia, can be effective in preventing catastrophic outcomes.
- Prompt diagnosis and multidisciplinary management are crucial for improving patient prognosis in such rare conditions.