Patch Infection Following Carotid Endarterectomy: A Single-Center Audit and Literature Review

TL;DR

This study reviews the management and outcomes of patch infections after carotid endarterectomy surgery over 23 years at a single hospital in Greece.

Contribution

The paper provides a long-term, single-center audit and literature review on a rare but serious complication of carotid surgery.

Findings

Seven patients with patch infections were treated, with Staphylococcus epidermidis and aureus being the most common organisms.

Six patients underwent successful debridement and vein grafting with no re-infections during a median 159-month follow-up.

One patient died from hemorrhagic shock before surgery, but no peri-operative deaths or strokes occurred in the remaining cases.

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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