Hybrid endovascular and surgical staged approach for mycotic carotid pseudoaneurysms: a case report and literature review

IF 1.6 4区医学 Q2 SURGERY

Frontiers in Surgery Pub Date : 2024-07-09 DOI:10.3389/fsurg.2024.1394441

Sallustro Marianna, Ficarelli Ilaria, Prisco Teresa, Pontarelli Armando, Foschini Giuseppe, Toni Marisole, Rinaldi Valerio, Nardi Priscilla, Piergaspare Palumbo, Illuminati Giulio, D’Andrea Vito, Ruotolo Carlo

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Abstract

BackgroundMycotic carotid pseudoaneurysms represent a challenge for surgeons. They are rare and associated with high mortality and morbidity.MethodsWe reported a case of a 61-year-old man with a mycotic pseudoaneurysm of carotid bifurcation. The case was managed by a staged procedure, starting with initial endovascular control using a stent graft, followed by open arterial reconstruction using a saphenous vein graft.ResultsThe patient was discharged home with a patent carotid artery and no sign of infection or bleeding. A computed tomography scan performed at 1 month, 6 months, and 1 year later confirmed good patency of the graft without imaging of cerebral ischemia.ConclusionsMycotic pseudoaneurysms of the extracranial carotid artery are rare and should always be treated surgically. This disease, despite its rarity, requires early detection and treatment to avoid fatal outcomes. A hybrid staged approach is suggested, compared to one-staged surgery, to avoid rupture and improve clinical outcomes. This approach involves using a stent graft combined with antibiotic therapy as bridge treatment until definitive surgery can be performed to enable arterial reconstruction with an autologous graft.

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治疗霉菌性颈动脉假性动脉瘤的血管内混合手术分期法：病例报告和文献综述

背景霉菌性颈动脉假性动脉瘤是外科医生面临的一项挑战。方法我们报告了一例患有颈动脉分叉处霉菌性假动脉瘤的 61 岁男性病例。结果患者出院回家时颈动脉通畅，无感染或出血迹象。1个月、6个月和1年后进行的计算机断层扫描证实，移植物的通畅性良好，无脑缺血影像。这种疾病尽管罕见，但需要早期发现和治疗，以避免致命后果。与单阶段手术相比，建议采用混合分阶段方法，以避免破裂并改善临床疗效。这种方法包括使用支架移植物结合抗生素治疗作为桥接治疗，直到可以进行最终手术，用自体移植物重建动脉。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Frontiers in Surgery Medicine-Surgery

CiteScore

1.90

自引率

11.10%

发文量

1872

审稿时长

12 weeks

期刊介绍： Evidence of surgical interventions go back to prehistoric times. Since then, the field of surgery has developed into a complex array of specialties and procedures, particularly with the advent of microsurgery, lasers and minimally invasive techniques. The advanced skills now required from surgeons has led to ever increasing specialization, though these still share important fundamental principles. Frontiers in Surgery is the umbrella journal representing the publication interests of all surgical specialties. It is divided into several “Specialty Sections” listed below. All these sections have their own Specialty Chief Editor, Editorial Board and homepage, but all articles carry the citation Frontiers in Surgery. Frontiers in Surgery calls upon medical professionals and scientists from all surgical specialties to publish their experimental and clinical studies in this journal. By assembling all surgical specialties, which nonetheless retain their independence, under the common umbrella of Frontiers in Surgery, a powerful publication venue is created. Since there is often overlap and common ground between the different surgical specialties, assembly of all surgical disciplines into a single journal will foster a collaborative dialogue amongst the surgical community. This means that publications, which are also of interest to other surgical specialties, will reach a wider audience and have greater impact. The aim of this multidisciplinary journal is to create a discussion and knowledge platform of advances and research findings in surgical practice today to continuously improve clinical management of patients and foster innovation in this field.