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Marianna S, Ilaria F, Teresa P, Armando P, Giuseppe F, Marisole T, Valerio R, Priscilla N, Palumbo P, Giulio I, Vito D, Carlo R. Hybrid endovascular and surgical staged approach for mycotic carotid pseudoaneurysms: a case report and literature review. Front Surg 2024; 11:1394441. [PMID: 39045087 PMCID: PMC11263163 DOI: 10.3389/fsurg.2024.1394441] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2024] [Accepted: 06/17/2024] [Indexed: 07/25/2024] Open
Abstract
Background Mycotic carotid pseudoaneurysms represent a challenge for surgeons. They are rare and associated with high mortality and morbidity. Methods We reported a case of a 61-year-old man with a mycotic pseudoaneurysm of carotid bifurcation. The case was managed by a staged procedure, starting with initial endovascular control using a stent graft, followed by open arterial reconstruction using a saphenous vein graft. Results The patient was discharged home with a patent carotid artery and no sign of infection or bleeding. A computed tomography scan performed at 1 month, 6 months, and 1 year later confirmed good patency of the graft without imaging of cerebral ischemia. Conclusions Mycotic pseudoaneurysms of the extracranial carotid artery are rare and should always be treated surgically. This disease, despite its rarity, requires early detection and treatment to avoid fatal outcomes. A hybrid staged approach is suggested, compared to one-staged surgery, to avoid rupture and improve clinical outcomes. This approach involves using a stent graft combined with antibiotic therapy as bridge treatment until definitive surgery can be performed to enable arterial reconstruction with an autologous graft.
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Affiliation(s)
| | | | - Prisco Teresa
- Vascular Surgery Unit, Cardarelli Hospital, Naples, Italy
| | | | | | - Toni Marisole
- Department of Surgical Sciences, University of Rome “La Sapeinza”, Rome, Italy
| | - Rinaldi Valerio
- Department of Surgical Sciences, University of Rome “La Sapeinza”, Rome, Italy
| | - Nardi Priscilla
- Department of Surgical Sciences, University of Rome “La Sapeinza”, Rome, Italy
| | - Piergaspare Palumbo
- Department of Surgical Sciences, University of Rome “La Sapeinza”, Rome, Italy
| | - Illuminati Giulio
- Department of Surgical Sciences, University of Rome “La Sapeinza”, Rome, Italy
| | - D’Andrea Vito
- Department of Surgical Sciences, University of Rome “La Sapeinza”, Rome, Italy
| | - Ruotolo Carlo
- Vascular Surgery Unit, Cardarelli Hospital, Naples, Italy
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Christoforou P, Constantinou C, Kounnos C, Kapoulas K, Salloumis M, Pantelas G, Hadjihannas L. A Rare and Dangerous Combination of COVID-19, Lemierre Syndrome, and Carotid Pseudoaneurysm: A Case Report. Vasc Specialist Int 2024; 40:22. [PMID: 38915225 PMCID: PMC11196942 DOI: 10.5758/vsi.240025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2024] [Revised: 04/28/2024] [Accepted: 05/10/2024] [Indexed: 06/26/2024] Open
Abstract
Lemierre syndrome is a rare complication of oropharyngeal infection that causes septic thrombophlebitis in the internal jugular vein. Since the onset of the COVID-19 pandemic, this condition has been dangerously overlooked and poses an even greater threat when complicated by vascular pathologies. A case is presented where the patient required emergency endovascular exclusion of a right internal carotid artery pseudoaneurysm due to Lemierre syndrome. The treatment included stent graft placement and drainage of a neck abscess, along with appropriate antibiotic treatment during hospitalization. Recognizing this diagnosis requires a high index of suspicion, particularly during the COVID-19 pandemic. The complexity of the disease necessitates extensive multidisciplinary collaboration for effective treatment.
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Affiliation(s)
| | - Costas Constantinou
- Infectious Diseases Unit, Department of Internal Medicine, Nicosia General Hospital, Nicosia, Cyprus
| | - Christos Kounnos
- Vascular and Endovascular Clinic, Nicosia General Hospital, Nicosia, Cyprus
| | | | - Marios Salloumis
- Oral and Maxillofacial Surgery Clinic, Nicosia General Hospital, Nicosia, Cyprus
| | - Georgios Pantelas
- Oral and Maxillofacial Surgery Clinic, Nicosia General Hospital, Nicosia, Cyprus
| | - Linos Hadjihannas
- Infectious Diseases Unit, Department of Internal Medicine, Nicosia General Hospital, Nicosia, Cyprus
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3
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Hanger M, Baker DM. Infective Native Extracranial Carotid Artery Aneurysms: A Systematic Review. Ann Vasc Surg 2023; 91:275-286. [PMID: 36549478 DOI: 10.1016/j.avsg.2022.11.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2022] [Revised: 11/16/2022] [Accepted: 11/26/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND Infective native extracranial carotid artery aneurysms are rare, and their management is variable due to a lack of evidence assessing outcomes. METHODS We performed a systematic literature review following PRISMA guidelines to identify all reported cases of infective native extracranial carotid artery aneurysms between January 1970 and March 2021. RESULTS This study identified 193 infective native aneurysms of the extracranial carotid artery from 154 sources. Patients were predominantly male (71.4%), and age ranged from 6 months to 89 years old. The most common presenting features were a neck mass and fever, but also included hemorrhage, respiratory distress, and neurological symptoms. Most aneurysms were located in the internal carotid artery (47.4%). Staphylococcus (23.3%) was the most commonly identified causative pathogen, followed by Mycobacterium tuberculosis (20.9%). Most appeared to become infected by direct local spread. Treatment strategies involved open surgical methods in 101 cases and an endovascular approach in 41 cases. In 4 cases, a hybrid method involving concurrent endovascular and open surgical management was undertaken. In 5 cases, there was antibiotic treatment alone. In the open surgery-treated group, the complication rate was 20.8% compared to 13.2% in the endovascular group. Mortality rate was 5.6%. CONCLUSIONS Our review identified 193 cases of infective native extracranial carotid artery aneurysms. Direct local spread of a staphylococcus infection was the commonest cause. Endovascular management was associated with fewer early complications than open surgical management.
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Affiliation(s)
- Melissa Hanger
- UCL Division of Medicine, Royal Free Campus, University College London, London, UK
| | - Daryll M Baker
- UCL Division of Medicine, Royal Free Campus, University College London, London, UK.
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4
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Dai YL, Chen VM, Hedges TR, Malek A. Lemierre syndrome associated mycotic cavernous sinus thrombosis and carotid aneurysm after COVID-19. Am J Ophthalmol Case Rep 2022; 27:101642. [PMID: 35782172 PMCID: PMC9238024 DOI: 10.1016/j.ajoc.2022.101642] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Revised: 06/20/2022] [Accepted: 06/27/2022] [Indexed: 11/29/2022] Open
Abstract
Purpose The purpose of this article is to report a case of Lemierre syndrome associated mycotic aneurysm of the intracavernous carotid artery leading to cavernous sinus syndrome in an otherwise healthy, young man in the setting of COVID-19 infection. Observations An 18-year-old, otherwise healthy male athlete developed fever, chills, and headache and was found to be positive for COVID-19 with gram negative bacteremia. While on systemic antibiotic treatment, he developed acute, left-sided, 6th nerve palsy and was found to have bacterial sinusitis, left-sided intracavernous mycotic aneurysm, and cavernous sinus thrombosis on imaging studies. Despite systemic antibiotic and antiplatelet therapy, he developed progressively worsening left-sided ophthalmoplegia and vision decline. He subsequently underwent left internal carotid artery embolization and cervical internal carotid artery sacrifice with excellent outcome. Conclusion and importance Lemierre syndrome can have atypical presentations and complications, including cavernous sinus thrombosis and mycotic aneurysms. Recognition of signs and symptoms, including progressive multiple cranial neuropathies, can aid in early diagnosis and management, which requires multidisciplinary care tailored to each individual based on risk of intervention.
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Affiliation(s)
- Yi Ling Dai
- Department of Ophthalmology, New England Eye Center, Tufts Medical Center, Boston, USA
- Corresponding author. New England Eye Center/Tufts Medical Center, Department of Ophthalmology, 800 Washington Street, Boston, MA, 02116, USA.
| | - Vicki M. Chen
- Department of Ophthalmology, New England Eye Center, Tufts Medical Center, Boston, USA
| | - Thomas R. Hedges
- Department of Ophthalmology, New England Eye Center, Tufts Medical Center, Boston, USA
- Department of Neurology, Tufts Medical Center, Boston, USA
| | - Adel Malek
- Department of Neurosurgery, Tufts Medical Center, Boston, USA
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5
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Lui DH, Patel S, Khurram R, Joffe M, Constantinou J, Baker D. Mycotic internal carotid artery pseudoaneurysm secondary to Mycobacterium tuberculosis. J Vasc Surg Cases Innov Tech 2022; 8:251-255. [PMID: 35516167 PMCID: PMC9065464 DOI: 10.1016/j.jvscit.2022.02.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Accepted: 02/28/2022] [Indexed: 12/02/2022] Open
Abstract
Mycobacterium tuberculosis is a rare causative agent for mycotic aneurysms of the extracranial carotid arteries. We describe a case of acute mycotic pseudoaneurysm and abscess in the right proximal internal carotid artery in close proximity to the carotid bifurcation, and subsequent management with antibiotic therapy, surgical debridement and resection with an end-to-end anastomosis.
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Affiliation(s)
- Dennis H. Lui
- Department of Vascular Surgery, Royal Free London NHS Foundation Trust, Royal Free Hospital, London, UK
- Divison of Surgery and Interventional Science, University College London, London, UK
- Correspondence: Dennis H. Lui, MBChB, Royal Free London NHS Foundation Trust, Royal Free Hospital, Pond St, London NW3 2QG, UK
| | - Shreena Patel
- Department of Clinical Radiology, Royal Free London NHS Foundation Trust, Royal Free Hospital, London, UK
| | - Ruhaid Khurram
- Department of Clinical Radiology, Royal Free London NHS Foundation Trust, Royal Free Hospital, London, UK
| | - Michael Joffe
- Department of Clinical Radiology, Royal Free London NHS Foundation Trust, Royal Free Hospital, London, UK
| | - Jason Constantinou
- Department of Vascular Surgery, Royal Free London NHS Foundation Trust, Royal Free Hospital, London, UK
| | - Daryl Baker
- Department of Vascular Surgery, Royal Free London NHS Foundation Trust, Royal Free Hospital, London, UK
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Bordet M, Long A, Tresson P. Mycotic Pseudoaneurysm of Carotid Artery as a Rare Complication of Lemierre Syndrome. Mayo Clin Proc 2021; 96:3178-3179. [PMID: 34863401 DOI: 10.1016/j.mayocp.2021.10.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Accepted: 10/12/2021] [Indexed: 11/19/2022]
Affiliation(s)
- Marine Bordet
- Department of Vascular and Endovascular Surgery, Hôpital Louis Pradel, Hospices Civils de Lyon, Lyon, France; Université Claude Bernard Lyon 1, Lyon, France.
| | - Anne Long
- Department of Internal Medicine and Vascular Medicine, Groupement Hospitalier Edouard Herriot, Hospices Civils de Lyon, France; Université Claude Bernard Lyon 1, Interuniversity Laboratory of Human Movement Biology EA7424, team Atherosclerosis, Thrombosis and Physical Activity, Lyon, France
| | - Philippe Tresson
- Department of Vascular and Endovascular Surgery, Hôpital Louis Pradel, Hospices Civils de Lyon, Lyon, France
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Matano F, Suzuki M, Mizunari T, Yamada T, Murai Y, Morita A. Radial Artery Graft for Giant Common Carotid Artery Pseudoaneurysm After Carotid Artery Stenting. World Neurosurg 2020; 139:401-404. [PMID: 32360920 DOI: 10.1016/j.wneu.2020.04.173] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Accepted: 04/22/2020] [Indexed: 11/16/2022]
Abstract
BACKGROUND We present a patient who underwent left superior temporal artery (STA)-to-right middle cerebral artery (MCA) bypass using a radial artery (RA) graft with resection of a giant right cervical common carotid artery (CCA) pseudoaneurysm after carotid artery stenting (CAS) and discuss the treatment strategy and surgical procedure in detail. CASE DESCRIPTION An 86-year-old male presented with sudden onset of altered consciousness and complete left hemiparesis. Magnetic resonance angiography and catheter angiography of the brain revealed occlusion of the right cervical ICA. Endovascular thrombectomy and stenting of the cervical segment of the ICA were performed. Thirty-two days after CAS, the patient developed a high fever and rapid swelling of the neck. Catheter angiography showed a giant right CCA pseudoaneurysm that had a fistula just proximal to the carotid stent, and the aneurysm extended to the neck entirely. Because of the expanding neck infection, stent placement long lesion, and lack of distal collateral flow on angiography, we performed aneurysm and stent removal and left STA-to-right MCA bypass using an RA graft. The harvested RA graft was anastomosed side to end to both the M2 segment of the right MCA and the left STA. Bypass patency was confirmed before neck exposure. The pseudoaneurysm and proximal portion area of the stent were resected. The patient recovered well postoperatively, and follow-up catheter angiography showed patency of the bypass. CONCLUSIONS Left STA-RA-right MCA bypass with aneurysm resection is a good treatment option for giant CCA pseudoaneurysms that occur after CAS.
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Affiliation(s)
- Fumihiro Matano
- Department of Neurosurgery, Chiba Hokusoh Hospital, Chiba, Japan.
| | - Masanori Suzuki
- Department of Neurosurgery, Chiba Hokusoh Hospital, Chiba, Japan
| | | | - Toshimasa Yamada
- Department of Neurosurgery, Chiba Hokusoh Hospital, Chiba, Japan
| | - Yasuo Murai
- Department of Neurological Surgery, Nippon Medical School, Tokyo, Japan
| | - Akio Morita
- Department of Neurological Surgery, Nippon Medical School, Tokyo, Japan
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Coburn JA, Golden E, Brucker J, Kennedy TA. Nontraumatic Vascular Emergencies of the Neck. Semin Ultrasound CT MR 2019; 40:157-171. [PMID: 31030739 DOI: 10.1053/j.sult.2018.10.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Nontraumatic vascular emergencies of the head and neck are uncommon, but can occur in patients with central venous catheters, head and neck infections, and in patients with head and neck cancer. Recognizing the imaging findings of vascular complications in these patient populations is critically important to ensure expeditious treatment to avoid significant morbidity and mortality.
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Affiliation(s)
- John A Coburn
- Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, WI
| | - Edwarda Golden
- Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, WI
| | - Justin Brucker
- Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, WI
| | - Tabassum A Kennedy
- Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, WI.
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Eriksen PRG, Hvilsom GB, Homøe P. Infected "Mycotic" Aneurysm of the Common Carotid Artery-A Differential Diagnosis to Tumor of the Neck. Front Surg 2019; 5:75. [PMID: 30619876 PMCID: PMC6297873 DOI: 10.3389/fsurg.2018.00075] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2018] [Accepted: 11/26/2018] [Indexed: 11/13/2022] Open
Abstract
Introduction: Infected "mycotic" Aneurysm (IA) of the extracranial carotid artery is a rare condition that can be fatal if mistaken for other pathology. An 83-year-old man presented with a mass on the neck initially suspected malignant. Weeks later it grew rapidly and was found to be an IA, thus requiring acute surgery. Via this case report, we discuss diagnostics and approach when diagnosing masses in relation to vessels of the neck not readily explained. Case Report: After diagnostic imaging and clinical assessment an unknown primary tumor of the neck was suspected. Fine needle aspiration was inconclusive. The patient did not present with any signs of infection or neurological symptoms-only discomfort and pain. Approximately two weeks later, the mass grew and the patient became dysphagic, febrile, and confused. Computed tomography angiography revealed an IA of the right common carotid artery. The patient underwent acute surgery consisting of ligation of the internal and external carotid arteries and resection of the internal jugular vein. The pathogen found was E. coli, supposedly from the bladder after surgical intervention due to polyposis. Conclusion: IA is a very rare entity and can have many etiologies. Since it can be fatal, it is necessary to keep IA in mind when diagnosing masses in relation to vessels of the neck. As shown in this case of a E. coli-induced IA, patients can present with atypical symptoms, on diagnostic imaging it can be mistaken for other pathology, and pathogenesis can be unclear.
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Affiliation(s)
- Patrick R G Eriksen
- Department of Otorhinolaryngology and Maxillofacial Surgery, Zealand University Hospital, Køge, Denmark
| | - Gitte B Hvilsom
- Department of Otorhinolaryngology and Maxillofacial Surgery, Zealand University Hospital, Køge, Denmark
| | - Preben Homøe
- Department of Otorhinolaryngology and Maxillofacial Surgery, Zealand University Hospital, Køge, Denmark
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Mesrar H, Mesrar J, Maillier B, Kraoua S, Chapoutot L, Delclaux B. Syndrome de Lemierre : diagnostic, exploration, traitement. Rev Med Interne 2018; 39:339-345. [DOI: 10.1016/j.revmed.2017.11.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2017] [Revised: 10/30/2017] [Accepted: 11/25/2017] [Indexed: 01/27/2023]
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