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Andrea E, Danilo M, Nicola GA, Pierluigi CA. Adjunctive techniques in endovascular repair of postcarotid endarterectomy pseudoaneurysm: Case report and literature review. Catheter Cardiovasc Interv 2023; 101:900-906. [PMID: 36906809 DOI: 10.1002/ccd.30619] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Revised: 12/14/2022] [Accepted: 02/27/2023] [Indexed: 03/13/2023]
Abstract
Pseudoaneurysm (PA) following carotid endarterectomy (CEA) is a rare and dangerous complication. In recent years endovascular approach has been preferred to open surgery as it is less invasive and reduces complications in an already operated neck, especially cranial nerve injuries. We report a case of large post-CEA PA causing dysphagia, successfully treated by deployment of two balloon-expandable covered stents and coil embolization of the external carotid artery. A literature review dealing with all cases of post-CEA PAs since 2000 treated by endovascular means is also reported. The research was conducted on Pubmed database using keywords "carotid pseudoaneurysm after carotid endarterectomy," "false aneurysm after carotid endarterectomy," "postcarotid endarterectomy pseudoaneurysm," and "carotid pseudoaneurysm."
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Affiliation(s)
- Esposito Andrea
- Department of Cardiovascular, Division of Vascular and Endovascular, San Carlo Hospital, Potenza, Italy
| | - Menna Danilo
- Department of Cardiovascular, Division of Vascular and Endovascular, San Carlo Hospital, Potenza, Italy
| | - Giordano A Nicola
- Department of Cardiovascular, Division of Vascular and Endovascular, San Carlo Hospital, Potenza, Italy
| | - Cappiello A Pierluigi
- Department of Cardiovascular, Division of Vascular and Endovascular, San Carlo Hospital, Potenza, Italy
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Heskett C, Brake A, Fry L, De Stefano FA, Lei C, Chatley K, Peterson J, Ebersole K. Treatment Options for Pseudoaneurysm After Carotid Endarterectomy: A Systematic Review and Illustrative Case. World Neurosurg 2022; 167:131-146. [PMID: 36058488 DOI: 10.1016/j.wneu.2022.08.124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Revised: 08/25/2022] [Accepted: 08/26/2022] [Indexed: 11/18/2022]
Abstract
BACKGROUND The goal of this study was to systematically review the management and outcomes of patients who developed pseudoaneurysm (PA) after carotid endarterectomy (postendarterectomy PA [PEPA]). METHODS Following the PRISMA guidelines, a systematic literature review was performed using PubMed, Scopus, and Web of Science databases from date of inception to June 2022. Studies were selected based on predetermined inclusion and exclusion criteria. Simultaneously, a retrospective review was conducted of patients who underwent neurosurgical evaluation of suspected PEPA at our institution. RESULTS Of the 321 articles in the original literature search, 62 were selected. A total of 143 patients (93 men, 27 women; mean age, 70.7 years) diagnosed with PEPA were included. Mean time from carotid endarterectomy to PA diagnosis was 41.8 months. Primary repair data were available for 135 patients, including 19 with primary closures, 112 with patch or graft repairs, and 4 with eversion procedures. Fifty-five patients with PA (39%) presented with infection. Staphylococcal species were the most common causative organism. Of infected PAs, 89.1% were treated with open procedures. Overall complication rates of PAs treated via open, endovascular, and hybrid methods were 31%, 15.4%, and 0%, respectively. Open ligation (42.9%) and aneurysmectomy with grafting (36.4%) resulted in the highest rates of complications. CONCLUSIONS Despite higher complication rates after open repair strategies, use of these techniques remains a viable option in situations requiring removal of infected patches or evacuation of large extravascular collections. Endovascular treatment options are associated with low numbers of complications and can be considered for primary PEPA treatment when infection is not present.
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Affiliation(s)
- Cody Heskett
- The University of Kansas School of Medicine, Kansas City, Kansas, USA.
| | - Aaron Brake
- The University of Kansas School of Medicine, Kansas City, Kansas, USA
| | - Lane Fry
- The University of Kansas School of Medicine, Kansas City, Kansas, USA
| | - Frank A De Stefano
- Department of Neurological Surgery, University of Kansas Health System, Kansas City, Kansas, USA
| | - Catherine Lei
- The University of Kansas School of Medicine, Kansas City, Kansas, USA
| | - Kevin Chatley
- Department of Neurological Surgery, University of Kansas Health System, Kansas City, Kansas, USA
| | - Jeremy Peterson
- Department of Neurological Surgery, University of Kansas Health System, Kansas City, Kansas, USA
| | - Koji Ebersole
- Department of Neurological Surgery, University of Kansas Health System, Kansas City, Kansas, USA
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Lopes A, Gomes ML, Sobrinho G, Pedro LM. Surgical Treatment of Post-Carotid Endarterectomy Carotid Pseudoaneurysm. EJVES Short Rep 2020; 46:12-13. [PMID: 31922037 PMCID: PMC6950783 DOI: 10.1016/j.ejvssr.2019.06.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2019] [Revised: 06/08/2019] [Accepted: 06/10/2019] [Indexed: 12/01/2022] Open
Abstract
Post-endarterectomy pseudoaneurysms (PEPA) are a rare complication of carotid endarterectomy (CEA), but are associated with high morbidity risk. Therefore, once they are diagnosed, treatment is urgent to prevent possible complications such as rupture, embolisation, thrombosis, or airway and cranial nerve compression. In this video, the surgical procedure is shown in a case of PEPA 10 years after CEA with patch angioplasty, which was successfully managed by surgical excision and interposition of great saphenous vein graft. Follow up duplex examination at six months was normal, with patency of the vein graft. This case reiterates the importance of open surgery as the treatment of choice for this difficult clinical setting.
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Affiliation(s)
- Alice Lopes
- Vascular Surgery Department-Heart and Vessels Division, Hospital de Santa Maria (CHLN), Lisbon, Portugal
- Lisbon Academic Medical Centre, Lisbon, Portugal
- Corresponding author. Hospital de Santa Maria, Serviço de Cirurgia Vascular, Avenida Professor Egas Moniz, 1649-035 Lisboa, Portugal.
| | - Miguel Lemos Gomes
- Vascular Surgery Department-Heart and Vessels Division, Hospital de Santa Maria (CHLN), Lisbon, Portugal
- Lisbon Academic Medical Centre, Lisbon, Portugal
| | - Gonçalo Sobrinho
- Vascular Surgery Department-Heart and Vessels Division, Hospital de Santa Maria (CHLN), Lisbon, Portugal
- Lisbon School of Medicine, University of Lisbon, Portugal
- Lisbon Academic Medical Centre, Lisbon, Portugal
| | - Luís Mendes Pedro
- Vascular Surgery Department-Heart and Vessels Division, Hospital de Santa Maria (CHLN), Lisbon, Portugal
- Lisbon School of Medicine, University of Lisbon, Portugal
- Lisbon Academic Medical Centre, Lisbon, Portugal
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Haruma J, Hirotsune N, Oka T, Arisawa T. Stent-assisted Coil Embolization to Treat Extracranial Carotid Artery Aneurysm 13 Years after Endarterectomy: A Case Report. NMC Case Rep J 2019; 7:23-27. [PMID: 31938678 PMCID: PMC6957776 DOI: 10.2176/nmccrj.cr.2019-0030] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2019] [Accepted: 06/06/2019] [Indexed: 12/27/2022] Open
Abstract
Development of extracranial carotid artery aneurysm (ECCA) after carotid endarterectomy (CEA) is a rare complication, occurring in connection with <1% of all CEAs. The main causes are infection, suture failure, and degeneration of arterial wall or patch. The traditional treatment has been operative repair, which can present a significant technical challenge owing to reoperative neck inflammation and potential cranial nerve injuries. Here, we report a case of successful stent-assisted coil embolization for right noninfectious ECCA. A 63-year-old female was admitted to our hospital for a 3-cm pulsating mass in her right midneck. Doppler examination and digital subtraction angiography revealed a large (15 mm) ECCA at the right common carotid artery (CCA). Thirteen years earlier, eversion CEA with patch angioplasty and abbreviation of the internal carotid artery (ICA) had been performed for a symptomatic 80% diameter stenosis with transient ischemic attack at another hospital. As the patient refused blood transfusion for religious reasons, we treated her with stent-assisted coil embolization, which achieved nearly complete obliteration of the aneurysm while preserving the parent artery patency. Three months after initial treatment, ultrasound revealed complete occlusion of the ECCA, but also showed stent shortening. Hence, we performed an additional stent placement so as to overlap the previous stent by 2.5 cm. Six months after initial treatment, carotid duplex ultrasound confirmed a good outcome. This procedure is an excellent choice for high-risk patients, and a larger case series is needed to establish this technique as the treatment of choice for ECCAs.
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Affiliation(s)
- Jun Haruma
- Department of Neurosurgery, Fukuyama City Hospital, Fukuyama, Hiroshima, Japan
| | - Nobuyuki Hirotsune
- Department of Neurosurgery, Hiroshima City Hospital, Hiroshima, Hiroshima, Japan
| | - Tetsuo Oka
- Department of Neurosurgery, Fukuyama City Hospital, Fukuyama, Hiroshima, Japan
| | - Tadashi Arisawa
- Department of Neurosurgery, Fukuyama City Hospital, Fukuyama, Hiroshima, Japan
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Endovascular Treatment with Two Overlapping Micromesh-Covered Stents and Balloon Guide Catheter for Symptomatic Carotid Pseudoaneurysm Ten Years after Eversion Endarterectomy. Ann Vasc Surg 2019; 58:379.e9-379.e13. [DOI: 10.1016/j.avsg.2018.10.026] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2018] [Revised: 10/09/2018] [Accepted: 10/10/2018] [Indexed: 11/23/2022]
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Varetto G, Trevisan A, Barile G, Gibello L, Spalla F, Frola E, Pennica D, Rispoli P. Carotid Pseudoaneurysm After Eversion Endarterectomy: A Case Report and Review of the Literature. Vasc Endovascular Surg 2018. [DOI: 10.1177/1538574418761981] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background: Pseudoaneurysm (PA) after carotid endarterectomy (CEA) is a rare and potentially life-threatening complication, with an incidence lower than 1%. Most of the cases described report PAs after carotid patch angioplasty and are associated with infection, often caused by Staphylococci. The management of PAs can be surgical, endovascular, or hybrid. Methods: We herein present the case of an infected carotid PA 27 days after an eversion CEA. We performed a common to internal carotid bypass with the interposition of great saphenous vein (GSV) associated with specific polyantibiotic therapy for 4 weeks. We searched the PubMed database for reviews and cases reports for patients who developed carotid PA after primary repair CEA in the period between 1969 and 2017. Results: We identified 21 cases of primary closure post-CEA PAs in the literature. In almost 60% of patients, infection was detected. Open surgery was performed in all the cases; in 1 case, an hybrid approach was preferred. In 52% of cases, a vein graft/patch or primary closure was chosen; in 3 cases, ligation was preferred, and in 1 case, a polyester graft was used. Conclusion: In our experience and with the evidence observed in the literature, open surgery with GSV interposition is the safest treatment in infected carotid PAs. The endovascular approach must be performed only in proven noninfectious cases. A bridge technique with the insertion of a stent followed by open surgery repair can be an option in emergency cases.
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Affiliation(s)
| | | | - Giovanni Barile
- Division of Vascular Surgery, University of Turin, Turin, Italy
| | - Lorenzo Gibello
- Division of Vascular Surgery, University of Turin, Turin, Italy
| | - Flavia Spalla
- Division of Vascular Surgery, University of Turin, Turin, Italy
| | - Edoardo Frola
- Division of Vascular Surgery, University of Turin, Turin, Italy
| | - Daniele Pennica
- Division of Vascular Surgery, University of Turin, Turin, Italy
| | - Pietro Rispoli
- Division of Vascular Surgery, University of Turin, Turin, Italy
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Young M, Imbarrato G, Gordhan A. Symptomatic Post Endarterectomy Common Carotid Artery Pseudoaneurysm Treated with Combination of Flow Diverter Implantation and Carotid Stenting. Neurointervention 2018. [PMID: 29535899 PMCID: PMC5847891 DOI: 10.5469/neuroint.2018.13.1.54] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
A 74-year-old male developed cervical carotid artery psuedoaneurysm 8 months after carotid endarterectomy. The patient was successfully managed with dual implantation of flow-diverter and conventional carotid stent. Flow-diverter was placed across the neck of pseudoaneurysm to provide flow diversion while carotid stent was implanted within the lumen of the expanded flow-diverter to approximate and hold the flow diverter proximal and distal to the pseudoaneurysm. Follow-up ultrasonography revealed complete resolution of the pseudoaneurysm.
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Affiliation(s)
- Michael Young
- Department of Neurosurgery, Advocate Health Care, Normal, IL, USA
| | - Greg Imbarrato
- Department of Neurosurgery, Advocate Health Care, Normal, IL, USA
| | - Ajeet Gordhan
- Department of Neurointerventional Radiology, Advocate Health Care, Normal, IL, USA
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Lysenko AV, Belov YV, Katkov AI, Komarov RN, Stonogin AV. [Surgical treatment of false aneurysm of internal carotid artery after carotid endarterectomy]. Khirurgiia (Mosk) 2016:80-84. [PMID: 27459493 DOI: 10.17116/hirurgia2016780-84] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- A V Lysenko
- Department of Cardiac Surgery of Clinic of Aortic and Cardiovascular Surgery, Sechenov First Moscow State Medical University, Moscow, Russia
| | - Yu V Belov
- Department of Cardiac Surgery of Clinic of Aortic and Cardiovascular Surgery, Sechenov First Moscow State Medical University, Moscow, Russia
| | - A I Katkov
- Department of Cardiac Surgery of Clinic of Aortic and Cardiovascular Surgery, Sechenov First Moscow State Medical University, Moscow, Russia
| | - R N Komarov
- Department of Cardiac Surgery of Clinic of Aortic and Cardiovascular Surgery, Sechenov First Moscow State Medical University, Moscow, Russia
| | - A V Stonogin
- Department of Cardiac Surgery of Clinic of Aortic and Cardiovascular Surgery, Sechenov First Moscow State Medical University, Moscow, Russia
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