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Roditis K, Tzamtzidou S, Maltezos K, Antoniou A, Giannakopoulos N, Tsiantoula P, Papas T. Patch Infection Following Carotid Endarterectomy: A Single-Center Audit and Literature Review. Cureus 2024; 16:e65420. [PMID: 39184741 PMCID: PMC11344968 DOI: 10.7759/cureus.65420] [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] [Accepted: 07/26/2024] [Indexed: 08/27/2024] Open
Abstract
INTRODUCTION Carotid endarterectomy (CEA) is a surgical procedure that carries a rare but serious risk of patch infection. This study examines the management and outcomes of patch infections in CEA patients treated in our department over 23 years. A literature review of studies on prosthetic patch infection following CEA published from January 1992 up to December 31, 2022 was also carried out. METHODS We conducted a retrospective audit of patients who underwent CEA in a hospital in Athens, Greece, between January 1, 1999, and December 31, 2022. RESULTS Between January 1999 and December 2022, we treated seven patients with carotid patch infections who had their original CEA at our department. Staphylococcus epidermidis and Staphylococcus aureus were the most common infecting organisms. One patient (14%) died from hemorrhagic shock before surgery, while the remaining six (86%) underwent debridement, patch excision, and great saphenous vein patching. No peri-operative deaths or strokes occurred, and there were no re-infections during a median follow-up of 159 months. CONCLUSIONS Excision of infected material followed by revascularization using a vein graft remains the prevailing treatment.
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Affiliation(s)
- Konstantinos Roditis
- Department of Vascular Surgery, Korgialenio-Benakio Hellenic Red Cross Hospital, Athens, GRC
| | - Sofia Tzamtzidou
- Department of Vascular Surgery, Korgialenio-Benakio Hellenic Red Cross Hospital, Athens, GRC
| | | | - Afroditi Antoniou
- Department of Vascular Surgery, Korgialenio-Benakio Hellenic Red Cross Hospital, Athens, GRC
| | - Nikolaos Giannakopoulos
- Department of Vascular Surgery, Korgialenio-Benakio Hellenic Red Cross Hospital, Athens, GRC
| | - Paraskevi Tsiantoula
- Department of Vascular Surgery, Korgialenio-Benakio Hellenic Red Cross Hospital, Athens, GRC
| | - Theofanis Papas
- Department of Vascular Surgery, Korgialenio-Benakio Hellenic Red Cross Hospital, Athens, GRC
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Johnston SK, Bennett T, Miller AJ. Intestinal perforation involving the Dacron cuff of nephrostomy tubes following subcutaneous ureteral bypass system implantation for ureteral obstructions in two cats. JFMS Open Rep 2021; 7:20551169211013295. [PMID: 34178373 PMCID: PMC8202293 DOI: 10.1177/20551169211013295] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
CASE SUMMARY This case report describes two cats that had subcutaneous ureteral bypass (SUB) systems implanted and subsequently developed duodenal perforations and septic peritonitis associated with the Dacron cuff of the nephrostomy tube. One cat recovered following surgical explantation of the SUB system with intestinal resection and anastomosis of the perforated small intestine, and - at the time of writing - is still alive. The other cat was humanely euthanased intraoperatively at the owner's request owing to its perceived prognosis. RELEVANCE AND NOVEL INFORMATION To our knowledge this is the first time this complication has been reported following SUB device placement.
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Affiliation(s)
| | | | - Amanda J Miller
- Small Animal Specialist Hospital, North Ryde, NSW, Australia
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Kirkton RD, Santiago-Maysonet M, Lawson JH, Tente WE, Dahl SLM, Niklason LE, Prichard HL. Bioengineered human acellular vessels recellularize and evolve into living blood vessels after human implantation. Sci Transl Med 2020; 11:11/485/eaau6934. [PMID: 30918113 DOI: 10.1126/scitranslmed.aau6934] [Citation(s) in RCA: 126] [Impact Index Per Article: 31.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2018] [Accepted: 03/06/2019] [Indexed: 12/13/2022]
Abstract
Traditional vascular grafts constructed from synthetic polymers or cadaveric human or animal tissues support the clinical need for readily available blood vessels, but often come with associated risks. Histopathological evaluation of these materials has shown adverse host cellular reactions and/or mechanical degradation due to insufficient or inappropriate matrix remodeling. We developed an investigational bioengineered human acellular vessel (HAV), which is currently being studied as a hemodialysis conduit in patients with end-stage renal disease. In rare cases, small samples of HAV were recovered during routine surgical interventions and used to examine the temporal and spatial pattern of the host cell response to the HAV after implantation, from 16 to 200 weeks. We observed a substantial influx of alpha smooth muscle actin (αSMA)-expressing cells into the HAV that progressively matured and circumferentially aligned in the HAV wall. These cells were supported by microvasculature initially formed by CD34+/CD31+ cells in the neoadventitia and later maintained by CD34-/CD31+ endothelial cells in the media and lumen of the HAV. Nestin+ progenitor cells differentiated into either αSMA+ or CD31+ cells and may contribute to early recellularization and self-repair of the HAV. A mesenchymal stem cell-like CD90+ progenitor cell population increased in number with duration of implantation. Our results suggest that host myogenic, endothelial, and progenitor cell repopulation of HAVs transforms these previously acellular vessels into functional multilayered living tissues that maintain blood transport and exhibit self-healing after cannulation injury, effectively rendering these vessels like the patient's own blood vessel.
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Affiliation(s)
| | | | - Jeffrey H Lawson
- Humacyte Inc., Durham, NC 27713, USA.,Departments of Surgery and Pathology, Duke University Medical Center, Durham, NC 27710, USA
| | | | | | - Laura E Niklason
- Humacyte Inc., Durham, NC 27713, USA.,Departments of Anesthesiology and Biomedical Engineering, Yale University, New Haven, CT 06511, USA
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Chakfé N, Diener H, Lejay A, Assadian O, Berard X, Caillon J, Fourneau I, Glaudemans AWJM, Koncar I, Lindholt J, Melissano G, Saleem BR, Senneville E, Slart RHJA, Szeberin Z, Venermo M, Vermassen F, Wyss TR, de Borst GJ, Bastos Gonçalves F, Kakkos SK, Kolh P, Tulamo R, Vega de Ceniga M, von Allmen RS, van den Berg JC, Debus ES, Koelemay MJW, Linares-Palomino JP, Moneta GL, Ricco JB, Wanhainen A. Editor's Choice - European Society for Vascular Surgery (ESVS) 2020 Clinical Practice Guidelines on the Management of Vascular Graft and Endograft Infections. Eur J Vasc Endovasc Surg 2020; 59:339-384. [PMID: 32035742 DOI: 10.1016/j.ejvs.2019.10.016] [Citation(s) in RCA: 283] [Impact Index Per Article: 70.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
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Hidden danger in the neck-a problem of differential diagnostics: benign chronic lymphadenitis following carotid endarterectomy and patch angioplasty (CEAP) or a metastasis due to a squamous cell cancer of the tongue. Oral Maxillofac Surg 2019; 23:307-310. [PMID: 31286292 DOI: 10.1007/s10006-019-00791-0] [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: 06/06/2019] [Accepted: 06/30/2019] [Indexed: 10/26/2022]
Abstract
INTRODUCTION Oncological head and neck operations as well as carotid endarterectomy are common surgical procedures. In some occasions, both procedures have occurred in the past, leading to possible diagnostic and therapeutic challenges when follow-up operations seem indicated. CASE REPORT We report of a patient presenting with carotid endarterectomy including patch operation 8 years ago and neck dissection due to a squamous cell cancer of the tongue 3 months ago, now showing up with a suspected metastatic tumor of the neck during routine follow-up. Intraoperatively, nearly fatal bleeding occurs due to a partial release of the carotid patch and needs to be managed immediately. DISCUSSION The primarily pre-operated neck remains challenging for the radiologist in terms of differentiating between chronic lymphadenitis and metastasis. Furthermore, it remains challenging for the oncological surgeon in case these entities are in the near proximity of the previously operated carotid artery. The operative treatment according to the guidelines can lead to major bleeding during the second surgery. During the diagnostic process, metastases and chronic lymphadenitis after alloplastic carotid operations must be differentiated remaining however difficult, due to only scarce data in the literature. CONCLUSION In the case of previous neck surgery, the decision to operate must be chosen individually regarding the specific conditions and their sometimes vital risks. In case an operation is indicated, the team must be trained to treat life-threatening intraoperative bleeding. In reviewing the literature, we were unable to find published recommendations on how to tackle these challenges.
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Abstract
Carotid endarterectomy (CEA) is a surgical intervention that may prevent stroke in asymptomatic and symptomatic patients. Our aim was to examine the microsurgical anatomy of carotid artery and other related neurovascular structures to summarize the CEA that is currently applied in ideal conditions. The upper necks of 2 adult cadavers (4 sides) were dissected using ×3 to ×40 magnification. The common carotid artery, external carotid artery (ECA), and internal carotid artery were exposed and examined. The surgical steps of CEA were described using 3-D cadaveric photos and computed tomography angiographic pictures obtained with help of OsiriX imaging software program. Segregating certain neurovascular and muscular structures in the course of CEA significantly increased the exposure. The division of facial vein allowed for internal jugular vein to be mobilized more laterally and dividing the posterior belly of digastric muscle resulted in an additional dorsal exposure of almost 2 cm. Isolating the ansa cervicalis that pulls hypoglossal nerve inferiorly allowed hypoglossal nerve to be released safely medially. The locations of the ECA branches alter depending on their anatomical variations. The hypoglossal nerve, glossopharyngeal nerve, and accessory nerve pierce the fascia of the upper part of the carotid sheath and they are vulnerable to injury because of their distinct courses along the surgical route. Surgical exposure in CEA requires meticulous dissection and detailed knowledge of microsurgical anatomy of the neck region to avoid neurovascular injuries and to determine the necessary surgical maneuvers in cases with neurovascular variations.
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Lejay A, Koncar I, Diener H, Vega de Ceniga M, Chakfé N. Post-operative Infection of Prosthetic Materials or Stents Involving the Supra-aortic Trunks: A Comprehensive Review. Eur J Vasc Endovasc Surg 2018; 56:885-900. [PMID: 30121172 DOI: 10.1016/j.ejvs.2018.07.016] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2018] [Accepted: 07/11/2018] [Indexed: 12/29/2022]
Abstract
OBJECTIVE The aim of this paper was to provide recommendations for diagnosis and management in the setting of infection following open or endovascular reconstructions of the supra-aortic trunks. METHODS A review of the Medline database was performed from 1997 to 2017 by a combined strategy of MeSh terms. RESULTS The literature search identified 49 publications: 36 studies addressing prosthetic material infections and 13 studies addressing stent infections. A total of 140 cases of prosthetic material infections were reported, mostly involving carotid patches. Surgical treatment was mostly based on complete removal of the infected material followed by in situ arterial reconstruction (86 cases, 62.3%). Peri-operative complications included cranial nerve injury in 17 cases (12.5%), stroke in eight (6.7%), bleeding in four (2.9%), re-infection in five (3.6%), and cardiac failure in three cases (2.2%). Stent infections were reported in 12 patients: eight carotid stents, three subclavian stents and one tandem brachiocephalic subclavian stent. Treatment was not described for one case, was conservative in one case, consisted of stent removal with venous reconstruction in six cases, stent removal without reconstruction because of carotid thrombosis in two cases, and carotid embolisation in two cases. Complications included intra-operative death in one case (9.1%), stroke in two (18.2%), reinfection in one (9.1%), bleeding in one (9.1%), and cardiac failure in one case (9.1%). CONCLUSION Appropriate pre-operative imaging is mandatory and treatment modality should be determined by patient condition. Complete removal of the infected material, followed by in situ arterial reconstruction with venous material seems advisable, despite high morbidity. However, alternative strategies may be considered for fragile and high risk patients. A multidisciplinary approach is mandatory to ensure optimum results.
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Affiliation(s)
- Anne Lejay
- Department of Vascular Surgery and Kidney Transplantation, University Hospital, Strasbourg, France.
| | - Igor Koncar
- Clinic for Vascular and Endovascular Surgery, Belgrade, Serbia
| | - Holger Diener
- Department of Vascular Medicine University Heart Centre, Hamburg, Germany
| | - Melina Vega de Ceniga
- Department of Angiology and Vascular Surgery, Hospital de Galdakao-Usansolo, Bizkaia, Spain
| | - Nabil Chakfé
- Department of Vascular Surgery and Kidney Transplantation, University Hospital, Strasbourg, France
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Ricco JB, Gargiulo M. Commentary on "Late Dacron Patch Inflammatory Reaction After Carotid Endarterectomy". Eur J Vasc Endovasc Surg 2017; 54:430. [PMID: 28811230 DOI: 10.1016/j.ejvs.2017.07.021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2017] [Accepted: 07/20/2017] [Indexed: 11/18/2022]
Affiliation(s)
- J-B Ricco
- University of Poitiers Medical School, Poitiers, France.
| | - M Gargiulo
- Unit of Vascular Surgery, Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Policlinico Sant'Orsola - Malpighi, Bologna, Italy
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