[Cervical epidural anesthesia for carotid mycotic aneurysms]

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.