Carotid artery pseudoaneurysm after carotid endarterectomy: case series and a review of the literature.
BACKGROUND
Pseudoaneurysm (PA) after carotid endarterectomy (CEA) is a rare complication with incidence less than 1%. There is a potential for rupture, embolization, thrombosis or compression of cranial nerves.


OBJECTIVE
We reviewed our experience and compare it to the literature to raise awareness of this rare though serious condition. It is crucial to treat these patients early to avoid the hazardous consequences.


METHODS
A review of the case records of patients who had CEA at University Hospital Birmingham (UHB) NHS Foundation Trust from 1990-2007, was undertaken. Information of patients including their aetiology, presenting features, treatment and results was collected. The English-language literature was searched using PubMed database for post CEA pseudoaneurysm.


RESULTS
Five patients developed post CEA PA. This represents 0.4% of the 1200 CEA performed at our hospital in the last 18 years. The timing of their presentation varied from three days to eight months after the original operation. All had patch reconstruction after CEA. Patches were intact at exploration of the PAs. There was one death and one stroke. The literature revealed 154 carotid PAs after CEA and two cases following carotid stenting 52 of these cases had infected PA. Patients with synthetic patches have the least incidence of infection. More than 80% had open surgery and 9% had endovascular repair.


CONCLUSIONS
Post CEA surveillance is necessary to detect patients with PA early. Factors that favour infection must be avoided. Endovascular repair of carotid PA should be encouraged in specialised centres.
Abdelhamid
Mohamed F
MF
Department of Vascular Surgery, University Hospital Birmingham NHS Foundation Trust, Selly Oak Hospital, Birmingham, UK. m.f.abdelhamid@btinternet.com
Wall
Michael L
ML
Vohra
Rajiv K
RK
D000368:Aged; D000369:Aged, 80 and over; D017541:Aneurysm, False / Q000209:etiology* / Q000401:mortality / Q000601:surgery; D019917:Blood Vessel Prosthesis Implantation; D002340:Carotid Artery Diseases / Q000209:etiology* / Q000401:mortality / Q000601:surgery; D016894:Endarterectomy, Carotid / Q000009:adverse effects* / Q000401:mortality; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012086:Reoperation; D020521:Stroke / Q000209:etiology; D013530:Surgical Wound Infection / Q000209:etiology; D013536:Suture Techniques / Q000009:adverse effects; D013997:Time Factors; D016896:Treatment Outcome; D014680:Veins / Q000637:transplantation