Postoperative infection associated with polyester patch angioplasty after carotid endarterectomy.
OBJECTIVE
Postoperative infection is one of the most dreaded complications associated with use of synthetic patches for carotid endarterectomy. Although polyester patches were used extensively for carotid patch angioplasty throughout the last decade, few reports detail cases of deep patch infection. We describe our experience with polyester patch infections after carotid endarterectomy. Patients and methods From January 1996 through December 2001 we treated polyester patch infections after carotid endarterectomy in 10 patients.


RESULTS
The interval from primary carotid endarterectomy to presentation with infection ranged from 11 days to 30 months. All patients underwent repeat operation that involved tissue debridement, excision of the polyester patch, and either interposition grafting or patch angioplasty with autologous vein. No perioperative stroke or death occurred; however, 1 patient had transient hoarseness, and in 1 patient a pseudoaneurysm developed that required additional surgical repair with a saphenous vein interposition graft. All patients remain well and free of infection with follow-up as long as 56 months.


CONCLUSIONS
Infection is a serious and rare complication of carotid patch angioplasty with polyester material. Nonetheless, it can be treated successfully with good results and acceptable morbidity with soft tissue debridement, prosthetic patch excision, and either patch angioplasty or interposition grafting with autologous vein.
Rockman
Caron B
CB
Division of Vascular Surgery, New York University Medical Center, 530 First Avenue, Suite 6F, New York, NY 10016, USA. caron.rockman@msnyuhealth.org
Su
William T
WT
Domenig
Christopher
C
Lamparello
Patrick J
PJ
Adelman
Mark A
MA
Jacobowitz
Glenn R
GR
Pomposelli
Frank B
FB
Riles
Thomas S
TS
D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D001807:Blood Vessel Prosthesis / Q000009:adverse effects*; D016894:Endarterectomy, Carotid / Q000009:adverse effects*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011091:Polyesters / Q000009:adverse effects*; D016459:Prosthesis-Related Infections / Q000209:etiology* / Q000628:therapy; D012086:Reoperation; D016896:Treatment Outcome; D014656:Vascular Surgical Procedures / Q000379:methods
D000900:Anti-Bacterial Agents; D011091:Polyesters