Successful management of mycotic anastomotic pseudoaneurysm of interposition vein graft following a carotid endarterectomy: a case report.

IF 0.9 Q3 MEDICINE, GENERAL & INTERNAL
Igor Kobza, Julia Mota, Glib Orel, Volodymyr Rogovskyi, Vasyl Pelekh
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引用次数: 0

Abstract

Background: Anastomotic pseudoaneurysms of interposition vein grafts are a rare entity that requires urgent management to prevent life-threatening complications, such as rupture and thromboembolism, especially when involving the carotid arteries. As these are rare complications and literature is sparse, we believe that this case report can aid the decision-making process in similar circumstances.

Case presentation: A 49-year-old Ukrainian male patient presented with a false aneurysm of both distal and proximal anastomosis of an interposition vein graft between the common carotid artery and the internal carotid artery, which was previously performed as a bailout procedure after the patient developed a complication of carotid surgery. The patient was successfully treated with extra-anatomical interposition of a vein graft from the subclavian artery to the remnant of extracranial internal carotid artery and en bloc excision of the previous vein graft with the false aneurysms.

Conclusion: Mycotic anastomotic pseudoaneurysms following carotid endarterectomy represent a rare yet serious complication in vascular surgery that requires urgent treatment. While endovascular techniques could represent an alternative option, open surgical repair is still the standard of care for this pathology, offering advantages in preventing postoperative ischemic complications and ensuring optimal long-term outcomes. The open approach provides direct visualization of the pseudoaneurysm. It allows the meticulous debridement of the infected tissues and an accurate reconstruction of the arterial wall with autologous or synthetic grafts. In light of the substantial evidence supporting its superiority, open surgical repair should remain the preferred approach in addressing mycotic anastomotic pseudoaneurysms following carotid endarterectomy. Future research should continue to explore advancements in other surgical techniques and refine treatment strategies to enhance patient outcomes in this challenging clinical scenario.

成功治疗颈动脉内膜剥脱术后霉菌性吻合器假性动脉瘤:病例报告。
背景:吻合口假性动脉瘤是一种罕见的静脉间置移植术,需要紧急处理以防止危及生命的并发症,如破裂和血栓栓塞,尤其是涉及颈动脉时。由于这些并发症非常罕见,文献也很少,我们相信本病例报告可以帮助类似情况下的决策过程:一名 49 岁的乌克兰男性患者因颈动脉总动脉和颈内动脉之间的静脉间置移植远端和近端吻合处均出现假性动脉瘤而就诊。患者在锁骨下动脉与颅内颈内动脉残余动脉之间进行了解剖外静脉穿刺移植,并全切了先前带有假性动脉瘤的静脉移植,治疗获得成功:结论:颈动脉内膜剥脱术后的霉菌性吻合口假动脉瘤是血管手术中一种罕见但严重的并发症,需要紧急治疗。虽然血管内技术可以作为一种替代选择,但开放手术修复仍是治疗这种病变的标准方法,它在预防术后缺血性并发症和确保最佳长期疗效方面具有优势。开放式方法可直接观察假性动脉瘤。它可以对感染组织进行细致的清创,并用自体或合成移植物准确地重建动脉壁。鉴于有大量证据支持开放手术修复的优越性,因此开放手术修复仍应是颈动脉内膜切除术后处理霉菌性吻合假性动脉瘤的首选方法。未来的研究应继续探索其他手术技术的进步,并完善治疗策略,以提高患者在这种具有挑战性的临床情况下的治疗效果。
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
Journal of Medical Case Reports
Journal of Medical Case Reports Medicine-Medicine (all)
CiteScore
1.50
自引率
0.00%
发文量
436
期刊介绍: JMCR is an open access, peer-reviewed online journal that will consider any original case report that expands the field of general medical knowledge. Reports should show one of the following: 1. Unreported or unusual side effects or adverse interactions involving medications 2. Unexpected or unusual presentations of a disease 3. New associations or variations in disease processes 4. Presentations, diagnoses and/or management of new and emerging diseases 5. An unexpected association between diseases or symptoms 6. An unexpected event in the course of observing or treating a patient 7. Findings that shed new light on the possible pathogenesis of a disease or an adverse effect
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