title: Management of carotid Dacron patch infection: a case report using median sternotomy for proximal common carotid artery control and in situ polytetrafluoroethylene grafting.
abstract: We report on a 58-year-old male who presented with an enlarging cervical hematoma 3 months following carotid endarterectomy with Dacron patch repair, due to septic disruption of the Dacron patch secondary to presumed infection. The essential features of this case are the control of the proximal common carotid artery gained through a median sternotomy, because the patient was markedly obese with minimal thyromental distance, and the treatment consisting of in situ polytetrafluoroethylene bypass grafting, due to the absence of a suitable autogenous saphenous vein. Median sternotomy is rarely required in case of reintervention for septic false aneurysms and hematomas following carotid endarterectomy but should be considered whenever difficult control of the common carotid artery, when entering the previous cervicotomy, is anticipated. In situ polytetrafluoroethylene grafting can be considered if autogenous vein material is lacking.
authors.affiliation: Francesco Durante Department of Surgery, University of Rome La Sapienza, Rome, Italy. giulio.illuminati@uniroma1.it
authors.forename: Giulio
authors.initials: G
authors.lastname: Illuminati
authors.forename: Francesco G
authors.initials: FG
authors.lastname: Calio'
authors.forename: Antonio
authors.initials: A
authors.lastname: D'Urso
authors.forename: Gianluca
authors.initials: G
authors.lastname: Ceccanei
authors.forename: Maria Antonietta
authors.initials: MA
authors.lastname: Pacilè
mesh_terms: D017541:Aneurysm, False / Q000382:microbiology / Q000601:surgery; D017542:Aneurysm, Ruptured / Q000382:microbiology / Q000601:surgery; D001807:Blood Vessel Prosthesis / Q000009:adverse effects*; D019917:Blood Vessel Prosthesis Implantation / Q000295:instrumentation*; D002340:Carotid Artery Diseases / Q000150:complications / Q000601:surgery*; D017536:Carotid Artery, Common / Q000382:microbiology / Q000601:surgery*; D016894:Endarterectomy, Carotid / Q000009:adverse effects* / Q000295:instrumentation; D006406:Hematoma / Q000382:microbiology / Q000601:surgery; D006801:Humans; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000150:complications; D011093:Polyethylene Terephthalates; D011138:Polytetrafluoroethylene; D011474:Prosthesis Design; D016459:Prosthesis-Related Infections / Q000382:microbiology / Q000601:surgery*; D012086:Reoperation; D013212:Staphylococcus epidermidis / Q000302:isolation & purification; D056346:Sternotomy
chemical_list: D011093:Polyethylene Terephthalates; D011138:Polytetrafluoroethylene