title: Prosthetic patch infection after carotid endarterectomy.
abstract: OBJECTIVE
  prospective audit of the management and outcome of prosthetic patch infection after carotid endarterectomy (CEA) at Leicester Royal Infirmary plus review of the literature.
  
  
  RESULTS
  8/936 CEA patients (0.85%) developed a prosthetic patch infection. Responsible organisms included MRSA (n=3), Staphylococcus epidermidis(n=2), haemolytic Streptococcus (n=1), Staphylococcus aureus(n=1) and Pseudomonas (n=1). Early wound complications preceded 4/5 infections presenting within 9 weeks of surgery. In addition to systemic antibiotics and debridement, management included patch removal and: (i) carotid ligation (n=3), vein patch repair (n=1), vein bypass (n=3). One patient had antibiotic irrigation of the in-situpatch. No patient died, one suffered a disabling postoperative stroke and two had temporary cranial nerve injuries. Including this series, a literature review identified 43 prosthetic patch infections, 91% culturing Staphylococci or Streptococci. Cumulative freedom from perioperative stroke/death or re-infection was 65% at 2 years. Patients treated by patch excision and autologous venous reconstruction had the best outcome with a cumulative freedom from perioperative stroke/death or re-infection of 91% at 2 years.
  
  
  CONCLUSIONS
  prosthetic patch infection after CEA is rare. This study emphasises the importance of close surveillance of early wound complications. Surgical decision-making, especially the safety of carotid ligation, was facilitated by access to transcranial Doppler.
authors.affiliation: Department of Vascular Surgery, Leicester Royal Infirmary, Leicester, UK.
authors.forename: A R
authors.initials: AR
authors.lastname: Naylor
authors.forename: D
authors.initials: D
authors.lastname: Payne
authors.forename: N J M
authors.initials: NJ
authors.lastname: London
authors.forename: M M
authors.initials: MM
authors.lastname: Thompson
authors.forename: M S
authors.initials: MS
authors.lastname: Dennis
authors.forename: R D
authors.initials: RD
authors.lastname: Sayers
authors.forename: P R F
authors.initials: PR
authors.lastname: Bell
mesh_terms: D001424:Bacterial Infections / Q000209:etiology* / Q000382:microbiology / Q000628:therapy; D002339:Carotid Arteries / Q000000981:diagnostic imaging; D003428:Cross Infection; D016894:Endarterectomy, Carotid / Q000009:adverse effects*; D006801:Humans; D016343:Monitoring, Intraoperative; D011446:Prospective Studies; D016459:Prosthesis-Related Infections / Q000382:microbiology / Q000628:therapy; D011552:Pseudomonas Infections / Q000209:etiology / Q000628:therapy; D013203:Staphylococcal Infections / Q000628:therapy; D013290:Streptococcal Infections / Q000628:therapy; D013526:Surgical Mesh / Q000009:adverse effects*; D017585:Ultrasonography, Doppler, Transcranial