title: Management and outcome of prosthetic patch infection after carotid endarterectomy: a single-centre series and systematic review of the literature.
abstract: OBJECTIVE
  Outcomes following prosthetic patch infection after carotid endarterectomy (CEA).
  
  
  METHODS
  Retrospective audit and systematic review.
  
  
  RESULTS
  22 patients were treated between January 1992 and April 2012, 5 having undergone their original CEA at another institution. The commonest infecting organism was Staphylococcus. One patient was treated by antibiotic irrigation, one was stented, while 20 underwent debridement and patch excision plus; carotid ligation (n = 3), vein patching (n = 3) or vein bypass (n = 14). There was one peri-operative stroke, but no peri-operative deaths. There were no reinfections at a median follow-up of 54 months. A systematic review identified 123 patients with prosthetic patch infection in the world literature. Thirty-six (29%) presented <2 months, 78 (63%) presented >6 months after the original CEA. Seventy-nine of/87 patients (91%) with a positive culture yielded Staphylococci or Streptococci. Seventy-four patients were treated by patch excision and autologous reconstruction. Four (5%) developed reinfection <30 days, but later reinfections have been reported. Seven of nine patients (78%) undergoing prosthetic reconstruction either died or suffered reinfection. Five patients were treated with a covered stent, none developing reinfection (median followup 12 months).
  
  
  CONCLUSIONS
  Patch infection following CEA is rare. Few have undergone stenting and long term data are awaited. For now, patch excision and autologous reconstruction remains the 'gold standard'.
authors.affiliation: Department of Vascular Surgery, Leicester Royal Infirmary, Infirmary Square, Leicester LE1 5WW, United Kingdom. chris.mann@doctors.org.uk
authors.forename: C D
authors.initials: CD
authors.lastname: Mann
authors.forename: M
authors.initials: M
authors.lastname: McCarthy
authors.forename: A
authors.initials: A
authors.lastname: Nasim
authors.forename: M
authors.initials: M
authors.lastname: Bown
authors.forename: M
authors.initials: M
authors.lastname: Dennis
authors.forename: R
authors.initials: R
authors.lastname: Sayers
authors.forename: N
authors.initials: N
authors.lastname: London
authors.forename: A R
authors.initials: AR
authors.lastname: Naylor
mesh_terms: D001807:Blood Vessel Prosthesis; D016893:Carotid Stenosis / Q000601:surgery; D019468:Disease Management; D016894:Endarterectomy, Carotid / Q000379:methods*; D006801:Humans; D011475:Prosthesis Failure; D016459:Prosthesis-Related Infections / Q000628:therapy*