Document Detail


Combined endovascular and surgical treatment of infected carotid-carotid bypass graft.
MedLine Citation:
PMID:  17042656     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
PURPOSE: To present a complex case involving an infected carotid-carotid bypass graft that was successfully treated with a stent-graft and subsequent surgical removal of the infected graft. CASE REPORT: A 75-year-old woman presented with persistent purulent drainage of an infected and exposed carotid-carotid prosthetic bypass graft. Wound cultures revealed methicillin-resistant Staphylococcus aureus. She was treated with appropriate intravenous antibiotic therapy without improvement in wound drainage. Because of her comorbid conditions, a decision was made to pursue endovascular revascularization of her left and right common carotid arteries (CCA), with subsequent surgical removal of the infected prosthetic graft. The patient underwent balloon angioplasty; a 7x18-mm Omnilink stent was deployed in the innominate artery and a 7x18-mm Herculink stent in the ostial left CCA. During the same procedure, the carotid-carotid bypass graft was excluded with deployment of an 8x50-mm Viabahn stent-graft in the right CCA. Several days later, the infected and now thrombosed carotid-carotid bypass graft was surgically removed, and an area of adjacent muscle was used to patch the previously excluded connection of the bypass from the right CCA. A saphenous vein patch was used to repair the defect in the left CCA. Her postoperative course was uneventful. At 1 year, the clinical and duplex examinations revealed satisfactory wound healing and patent left and right CCAs. CONCLUSION: This case indicates that a combined endovascular and surgical approach may be a safe and effective option in the treatment of carotid-carotid bypass graft infection.
Authors:
George Younis; George J Reul; Zvonimir Krajcer
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Publication Detail:
Type:  Case Reports; Journal Article    
Journal Detail:
Title:  Journal of endovascular therapy : an official journal of the International Society of Endovascular Specialists     Volume:  13     ISSN:  1526-6028     ISO Abbreviation:  J. Endovasc. Ther.     Publication Date:  2006 Oct 
Date Detail:
Created Date:  2006-10-17     Completed Date:  2007-02-02     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  100896915     Medline TA:  J Endovasc Ther     Country:  United States    
Other Details:
Languages:  eng     Pagination:  687-92     Citation Subset:  IM    
Affiliation:
Department of Cardiology, Texas Heart Institute, St. Luke's Hospital, Houston, TX 77030, USA.
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MeSH Terms
Descriptor/Qualifier:
Aged
Angioplasty, Balloon*
Blood Vessel Prosthesis Implantation* / instrumentation
Carotid Artery, Common / physiopathology,  surgery*
Carotid Stenosis / surgery*
Combined Modality Therapy
Endarterectomy, Carotid
Fatal Outcome
Female
Humans
Reoperation
Saphenous Vein / surgery
Staphylococcal Infections / complications,  microbiology,  surgery*
Staphylococcus aureus
Stents
Surgical Wound Infection / etiology,  surgery*
Vascular Patency
Wound Healing

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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