title: Combined endovascular and surgical treatment of infected carotid-carotid bypass graft.
abstract: OBJECTIVE
  To present a complex case involving an infected carotid-carotid bypass graft that was successfully treated with a stent-graft and subsequent surgical removal of the infected graft.
  
  
  METHODS
  A 75-year-old woman presented with persistent purulent drainage of an infected and exposed carotid-carotid prosthetic bypass graft. Wound cultures revealed methicillin-resistant Staphylococcus aureus. She was treated with appropriate intravenous antibiotic therapy without improvement in wound drainage. Because of her comorbid conditions, a decision was made to pursue endovascular revascularization of her left and right common carotid arteries (CCA), with subsequent surgical removal of the infected prosthetic graft. The patient underwent balloon angioplasty; a 7x18-mm Omnilink stent was deployed in the innominate artery and a 7x18-mm Herculink stent in the ostial left CCA. During the same procedure, the carotid-carotid bypass graft was excluded with deployment of an 8x50-mm Viabahn stent-graft in the right CCA. Several days later, the infected and now thrombosed carotid-carotid bypass graft was surgically removed, and an area of adjacent muscle was used to patch the previously excluded connection of the bypass from the right CCA. A saphenous vein patch was used to repair the defect in the left CCA. Her postoperative course was uneventful. At 1 year, the clinical and duplex examinations revealed satisfactory wound healing and patent left and right CCAs.
  
  
  CONCLUSIONS
  This case indicates that a combined endovascular and surgical approach may be a safe and effective option in the treatment of carotid-carotid bypass graft infection.
authors.affiliation: Department of Cardiology, Texas Heart Institute, St. Luke's Hospital, Houston, TX 77030, USA.
authors.forename: George
authors.initials: G
authors.lastname: Younis
authors.forename: George J
authors.initials: GJ
authors.lastname: Reul
authors.forename: Zvonimir
authors.initials: Z
authors.lastname: Krajcer
mesh_terms: D000368:Aged; D000800:Angioplasty, Balloon; D019917:Blood Vessel Prosthesis Implantation / Q000295:instrumentation; D017536:Carotid Artery, Common / Q000503:physiopathology / Q000601:surgery*; D016893:Carotid Stenosis / Q000601:surgery*; D003131:Combined Modality Therapy; D016894:Endarterectomy, Carotid; D017809:Fatal Outcome; D005260:Female; D006801:Humans; D012086:Reoperation; D012501:Saphenous Vein / Q000601:surgery; D013203:Staphylococcal Infections / Q000150:complications / Q000382:microbiology / Q000601:surgery*; D013211:Staphylococcus aureus; D015607:Stents; D013530:Surgical Wound Infection / Q000209:etiology / Q000601:surgery*; D014654:Vascular Patency; D014945:Wound Healing