IngentaConnect Mycotic Pseudoaneurysm Following Carotid Intervention

Abstract:

Introduction.—Pseudoaneurysm formation is a rare complication following carotid artery revascularization with a low estimated occurrence of 0.15 to 0.6%. This may result from percutaneous intervention, trauma, or infection. Patients may present with pain and swelling as well as a pulsatile cervical mass.

Case Report.—A 56-year-old male with a history of multiple carotid endarterectomies and an interposition synthetic graft presented with a recurrent high-grade stenosis. The patient underwent a balloon angioplasty and stent placement in the internal carotid artery. Two months postintervention, the patient presented with swelling and tenderness at the incision site. Color duplex ultrasound (CDU) was performed, demonstrating a 1.7 × 1.8 cm perigraft collection without evidence of flow. The patient returned in 2 weeks with increased swelling and discomfort. This prompted a repeat CDU, demonstrating a 3.7 × 3.9 cm hypoechoic, perigraft collection, now doubled in size from the previous exam. An abscess was confirmed by needle aspiration and positive culture results. He was admitted and underwent 6 weeks of antibiotic therapy. Upon discharge, the patient returned for a follow-up CDU. A perigraft collection with arterial flow was now present that had not previously been noted. Angiography confirmed extraluminal flow at the level of the carotid stent. The patient underwent operative debridement with excision of the infected graft and repair of the pseudoaneurysm.

Conclusions.—Carotid artery interventions have a very low incidence of infection. The occurrence of an infected or mycotic pseudoaneurysm following carotid intervention is extremely rare. CDU is a vital tool in detecting thrombosed versus active pseudoaneurysms, which may help guide appropriate therapeutic decisions.

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