title: Aseptic polyurethane carotid patch rejection: complication, allergy or miraculous healing?
abstract: Carotid endarterectomy plays an important role in the prevention of ischemic stroke; patching could reduce the risk of intra- and postoperative complications and late restenosis among primary closure. Materials actually available for the patch tailoring are synthetic or biological: which is the best is still debated. We present the case of a polyurethane (PU) carotid patch rejection three years after its implant, with no evident arterial discontinuity and no sign of infection. Histopathological analysis on hematoxylin-eosin stained sections of the regenerated arterial wall tissue removed revealed plasma cell infiltration and clusters of foreign body giant cells. PU patch rejection has been seldom described in literature. This is an unusual late complication that should be considered at long-term follow-up evaluation of these patients.
authors.affiliation: Vascular Surgery, San Raffaele Scientific Institute, Vita-Salute University, Milan, Italy. tshomba.yamume@hsr.it
authors.forename: Y
authors.initials: Y
authors.lastname: Tshomba
authors.forename: D
authors.initials: D
authors.lastname: De Dominicis
authors.forename: E M
authors.initials: EM
authors.lastname: Marone
authors.forename: D
authors.initials: D
authors.lastname: Mascia
authors.forename: F
authors.initials: F
authors.lastname: Sanvito
authors.forename: R
authors.initials: R
authors.lastname: Chiesa
mesh_terms: D058070:Asymptomatic Diseases; D016893:Carotid Stenosis / Q000000981:diagnostic imaging / Q000601:surgery*; D016894:Endarterectomy, Carotid / Q000009:adverse effects* / Q000295:instrumentation*; D004867:Equipment Design; D005549:Foreign-Body Reaction / Q000209:etiology* / Q000473:pathology / Q000601:surgery; D006801:Humans; D006967:Hypersensitivity / Q000209:etiology* / Q000473:pathology / Q000601:surgery; D008297:Male; D008875:Middle Aged; D011140:Polyurethanes; D012086:Reoperation; D012501:Saphenous Vein / Q000637:transplantation; D012720:Severity of Illness Index; D013997:Time Factors; D016896:Treatment Outcome; D018616:Ultrasonography, Doppler, Duplex; D014945:Wound Healing
chemical_list: D011140:Polyurethanes