- 作者：C.D. Mann ; chris.mann@doctors.org.uk ; M. McCarthy ; A. Nasim ; M. Bown ; M. Dennis ; R. Sayers ; N. London ; A.R. Naylor
- 关键词：Prosthetic patch infection ; Carotid endarterectomy ; Management ; Systematic review
- 刊名：European Journal of Vascular and Endovascular Surgery
- 出版年：2012
- 期刊代码：122_10785884
- 类别：med
- 出版时间：July, 2012
- 卷：44
- 期：1
- 页码：20-26
- 文件大小：554 K
Objectives
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聽=聽3), vein patching (n聽=聽3) or vein bypass (n聽=聽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).
Conclusion
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 鈥榞old standard鈥?