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Larson AS, Bathla G, Brinjikji W, Lanzino G, Cheek-Norgan EH, Aubry MC, Huston J, Benson JC. A review of histopathologic and radiologic features of non-atherosclerotic pathologies of the extracranial carotid arteries. Neuroradiol J 2024:19714009241242592. [PMID: 38557110 DOI: 10.1177/19714009241242592] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/04/2024] Open
Abstract
Diseases of the carotid arteries can be classified into different categories based on their origin. Atherosclerotic carotid disease remains the most encountered arterial wall pathology. However, other less-common non-atherosclerotic diseases can have detrimental clinical consequences if not appropriately recognized. The underlying histological features of each disease process may result in imaging findings that possess features that are obvious of the disease. However, some carotid disease processes may have histological characteristics that manifest as non-specific radiologic findings. The purpose of this manuscript is to review various non-atherosclerotic causes of carotid artery disease as well as their histologic-radiologic characteristics to aid in the appropriate recognition of these less-commonly encountered pathologies.
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Affiliation(s)
| | | | - Waleed Brinjikji
- Department of Radiology, Mayo Clinic, USA
- Department of Neurosurgery, Mayo Clinic, USA
| | - Giuseppe Lanzino
- Department of Radiology, Mayo Clinic, USA
- Department of Neurosurgery, Mayo Clinic, USA
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2
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Hanger M, Baker DM. Infective Native Extracranial Carotid Artery Aneurysms: A Systematic Review. Ann Vasc Surg 2023; 91:275-286. [PMID: 36549478 DOI: 10.1016/j.avsg.2022.11.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2022] [Revised: 11/16/2022] [Accepted: 11/26/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND Infective native extracranial carotid artery aneurysms are rare, and their management is variable due to a lack of evidence assessing outcomes. METHODS We performed a systematic literature review following PRISMA guidelines to identify all reported cases of infective native extracranial carotid artery aneurysms between January 1970 and March 2021. RESULTS This study identified 193 infective native aneurysms of the extracranial carotid artery from 154 sources. Patients were predominantly male (71.4%), and age ranged from 6 months to 89 years old. The most common presenting features were a neck mass and fever, but also included hemorrhage, respiratory distress, and neurological symptoms. Most aneurysms were located in the internal carotid artery (47.4%). Staphylococcus (23.3%) was the most commonly identified causative pathogen, followed by Mycobacterium tuberculosis (20.9%). Most appeared to become infected by direct local spread. Treatment strategies involved open surgical methods in 101 cases and an endovascular approach in 41 cases. In 4 cases, a hybrid method involving concurrent endovascular and open surgical management was undertaken. In 5 cases, there was antibiotic treatment alone. In the open surgery-treated group, the complication rate was 20.8% compared to 13.2% in the endovascular group. Mortality rate was 5.6%. CONCLUSIONS Our review identified 193 cases of infective native extracranial carotid artery aneurysms. Direct local spread of a staphylococcus infection was the commonest cause. Endovascular management was associated with fewer early complications than open surgical management.
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Affiliation(s)
- Melissa Hanger
- UCL Division of Medicine, Royal Free Campus, University College London, London, UK
| | - Daryll M Baker
- UCL Division of Medicine, Royal Free Campus, University College London, London, UK.
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3
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Lee SH, Cho YK, Park JM, Chung C, Kim HS, Woo JJ. Treatment of an acute mycotic aneurysm of the common carotid artery with a covered stent-graft. Yonsei Med J 2012; 53:224-7. [PMID: 22187257 PMCID: PMC3250342 DOI: 10.3349/ymj.2012.53.1.224] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
We report herein a case successful endovascular treatment with a stent-graft of a rare case of rapidly growing mycotic aneurysm of the left common carotid artery due to acute bacterial endocarditis after eradication of the infection. Infected mycotic aneurysms of the peripheral vasculature have been considered as a contraindication for stent-graft implantation because of the possibility of microorganism spreading to the stent-graft; however, if there is evidence of complete eradication of microorganism and surgery is not an option, stent-graft implantation can be an effective and safe treatment modality for exclusion of the mycotic aneurysm.
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Affiliation(s)
- Suk Hoon Lee
- Department of Radiology, Eulji General Hospital, Eulji University, Seoul, Korea
| | - Young Kwon Cho
- Department of Radiology, Eulji General Hospital, Eulji University, Seoul, Korea
| | - Jong Moo Park
- Department of Neurology, Eulji General Hospital, Eulji University, Seoul, Korea
| | - Curie Chung
- Department of Neurology, Eulji General Hospital, Eulji University, Seoul, Korea
| | - Hyun Suk Kim
- Department of Radiology, Eulji General Hospital, Eulji University, Seoul, Korea
| | - Jeong Joo Woo
- Department of Radiology, Eulji General Hospital, Eulji University, Seoul, Korea
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4
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Aneurisma verdadero de carótida interna extracraneal. ANGIOLOGIA 2010. [DOI: 10.1016/s0003-3170(10)70039-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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5
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O'Connell JB, Darcy S, Reil T. Extracranial Internal Carotid Artery Mycotic Aneurysm: Case Report and Review. Vasc Endovascular Surg 2009; 43:410-5. [DOI: 10.1177/1538574409340590] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Mycotic aneurysms of the internal carotid artery (ICA) are rare and often difficult to diagnose. They can have nonspecific signs and symptoms, an unclear etiology, and can lead to severe morbidity and mortality if left untreated. We present a case of a 47-year-old woman with an apparent mycotic aneurysm of the extracranial ICA associated with Klebsiella pneumonia. We discuss the various clinical findings and radiographic imaging that lead to this unusual diagnosis and the details of our surgical treatment, which included excision of the mycotic aneurysm and reconstruction with a greater saphenous vein interposition graft. We also review the literature on mycotic aneurysms of the ICA, including the radiologic modalities available to diagnose this condition, epidemiology, pathophysiology, and treatment options.
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Affiliation(s)
- Jessica Beth O'Connell
- UCLA Gonda (Goldschmied) Vascular Center, David Geffen School of Medicine at University of California, Los Angeles, California,
| | - Sean Darcy
- UCLA Gonda (Goldschmied) Vascular Center, David Geffen School of Medicine at University of California, Los Angeles, California
| | - Todd Reil
- UCLA Gonda (Goldschmied) Vascular Center, David Geffen School of Medicine at University of California, Los Angeles, California
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6
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Mycotic aneurysm of internal carotid artery — A case report. Indian J Thorac Cardiovasc Surg 2008. [DOI: 10.1007/s12055-008-0023-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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7
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Masumoto H, Shimamoto M, Yamazaki F, Nakai M, Fujita S, Miura Y. Airway stenosis associated with a mycotic pseudoaneurysm of the common carotid artery. Gen Thorac Cardiovasc Surg 2008; 56:242-5. [PMID: 18470692 DOI: 10.1007/s11748-008-0230-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2007] [Accepted: 01/22/2008] [Indexed: 10/22/2022]
Abstract
A 56-year-old woman was seen who had been under hemodialysis treatment. In September 2003, the patient was sent to our hospital with fever and dyspnea, and artificial respiration was initiated. Bronchoscopy detected stenosis due to compression of the bronchus. Contrast computed tomography and angiography detected a pseudoaneurysm of the right common carotid artery. We performed emergency excision of the mycotic pseudoaneurysm, which was closed with an autologous pericardial patch. We also performed median sternotomy to obtain an adequate surgical view. A perfusion tube was inserted into the internal carotid artery. The inflammatory findings and dyspnea resolved postoperatively.
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Affiliation(s)
- Hidetoshi Masumoto
- Department of Cardiovascular Surgery, Shizuoka City Hospital, 10-93 Ote-machi, Shizuoka 420-8630, Japan.
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8
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Zhang J, Zhang X, Guo Q, Cao W, Zhang Q, Gao D, Lin W, Liu E. Surgical treatment of giant fusiform aneurysm of extracranial internal carotid artery in a child: 1 case report and literature review. ACTA ACUST UNITED AC 2007; 68:329-33; discussion 334. [PMID: 17719981 DOI: 10.1016/j.surneu.2006.10.052] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2006] [Accepted: 10/10/2006] [Indexed: 10/22/2022]
Abstract
BACKGROUND The objective of this study is to report diagnosis and treatment results of giant fusiform aneurysm of extracranial internal carotid artery in a child and review the relative reference to enhance the knowledge of it. METHODS A 13-year-old female patient was admitted to the hospital with chief complaint of pulsatile mass in her left cervical area for 1 year, which had abruptly augmented 2 months earlier. No cervical trauma or infection appeared. A 3.5 x 6-cm mass in the left cervical angle of the mandible was observed to beat with pulse without vascular murmur. Digital subtraction angiography and CTA showed a giant fusiform aneurysm 6 cm in length and 3 cm in maximum diameter from the beginning of the left internal carotid artery. After resection of the aneurysm, vascular continuity was restored by interposition of a 6-mm PTFE graft. RESULTS Pathologic examinations showed hyperplasia in artery wall, fibroplasias and mucous degeneration, hyalinization, chronic inflammatory cell infiltration, and local calcification. The recovery was good without complication. The patient was followed up in 2 years postoperation. The CTA and color Doppler ultrasonography showed good configuration and distribution of the internal carotid artery and good circulation in vascular cavity. CONCLUSIONS Giant fusiform aneurysm of extracranial internal carotid artery in children is rather rare. The main causes are atherosclerosis, infection and trauma, incurring by carotid endarterectomy, and the like. Most of the clinical manifestations are pulsatile nontender mass. It can cause severe complications, such as brain ischemia or cervical hematorrhea incurred by rupture of aneurysm. The therapy includes resection of the aneurysm and restoration of flow with venous, arterial, or prosthetic graft or endovascular stenting.
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Affiliation(s)
- Jianning Zhang
- Department of Neurosurgery, Xijing Hospital, Fourth Military Medical University, Xi'an 710032, PR China.
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Boulloche N, Slaoui T, Viguier A, Glock Y, Chabanon G, Rigal M, Larrue V. Ischemic cerebral attacks due to a pseudo-aneurysm of the internal carotid artery with Listeria monocytogenes. J Neurol 2007; 254:122-3. [PMID: 17260177 DOI: 10.1007/s00415-006-0314-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/15/2006] [Indexed: 10/23/2022]
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Angle N, Dorafshar AH, Ahn SS. Mycotic aneurysm of the internal carotid artery--a case report. Vasc Endovascular Surg 2003; 37:213-7. [PMID: 12799731 DOI: 10.1177/153857440303700309] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Extracranial internal carotid artery (ICA) mycotic aneurysms are rare entities that may result in significant neurologic morbidity and mortality. Several operative techniques have been described in the literature for the management of this difficult condition. This case report describes a contained ruptured mycotic aneurysm of the extracranial ICA associated with Proteus mirabilis infection successfully treated by an end-to-end spatulated interposition saphenous vein graft.
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Affiliation(s)
- Niren Angle
- UCLA Gonda Vascular Center, Los Angeles, CA 90095-6908, USA
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Glaiberman CB, Towbin RB, Boal DKB. Giant mycotic aneurysm of the internal carotid artery in a child: endovascular treatment. Pediatr Radiol 2003; 33:211-5. [PMID: 12612824 DOI: 10.1007/s00247-002-0844-y] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2002] [Accepted: 10/14/2002] [Indexed: 11/28/2022]
Abstract
We present a case of a giant mycotic aneurysm of the left internal carotid artery in a child, the result of direct extension of a deep neck space infection. This lesion is life threatening and may put the patient at risk of unwarranted biopsy or drainage if not recognized. Diagnosis and treatment planning rely heavily on cross-sectional imaging, and angiography is frequently necessary. This case is unique for two reasons: (1) we present for the first time the MRI findings and (2) we describe an alternative to surgical ligation -- neurointerventional embolotherapy. Minimally invasive transcatheter embolization was successfully performed on our patient to occlude the abnormal left internal carotid artery segment.
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Affiliation(s)
- Craig B Glaiberman
- Department of Radiology (H066), Milton S. Hershey Medical Center, Pennsylvania State University, P.O. Box 850, Hershey 17033, USA
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13
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Knouse MC, Madeira RG, Celani VJ. Pseudomonas aeruginosa causing a right carotid artery mycotic aneurysm after a dental extraction procedure. Mayo Clin Proc 2002; 77:1125-30. [PMID: 12374256 DOI: 10.4065/77.10.1125] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
Mycotic aneurysms of the carotid arteries are rare. We describe a right carotid artery mycotic aneurysm in a 70-year-old man. His symptoms began immediately after a complicated molar extraction and persisted until the diagnosis was made and surgical resection and repair were undertaken. Pseudomonas aeruginosa was isolated from multiple blood cultures and excised tissues. We review another 73 cases uncovered by an extensive literature search. Bacteremia, recent surgery, head and neck infections, dental infections, and endocarditis are the most common predisposing conditions. Computed tomography and magnetic resonance imaging are techniques for accurately confirming the suspicion of any aneurysm, but angiography is the gold standard. Primary resection of the aneurysm with native vein interposition, in conjunction with prolonged antibiotic therapy, is the preferred strategy. A total of 6 cases thus far, including ours, have been clearly associated with dental surgical procedures. These cases are characterized by rapidly enlarging neck masses in the presence of fever. Microorganisms, particularly gram-negative rods, in contrast to normal oral flora, eg, streptococci and anaerobes, are often isolated. With prompt diagnosis and treatment, outcome is often satisfactory.
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Affiliation(s)
- Mark C Knouse
- Division of Infectious Diseases, Lehigh Valley Hospital, Allentown, PA, USA.
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14
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Farman AG, Kushner GM, Gould AR. A sequential approach to radiological interpretation. Dentomaxillofac Radiol 2002; 31:291-8. [PMID: 12203127 DOI: 10.1038/sj.dmfr.4600716] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2002] [Revised: 05/17/2002] [Accepted: 05/30/2002] [Indexed: 11/09/2022] Open
Abstract
A case of large glandular odontogenic cyst of the mandible is presented in which the panoramic radiograph also demonstrated a soft tissue lesion consistent with carotid aneurysm. CT confirmed the bucco-lingual extent of the mandibular lesion and the presence of a soft tissue lesion consistent with an aneurysm of the internal carotid artery. CT angiography, MR angiography and US were used to rule out a carotid artery aneurysm prior to surgery of the mandibular lesion.
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Affiliation(s)
- A G Farman
- Department of Surgical and Hospital Dentistry, The University of Louisville, Louisville, Kentucky, USA.
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15
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Engelke C, Sandhu C, Morgan RA, Belli AM. Endovascular repair of thoracic aortic aneurysm and intramural hematoma in giant cell arteritis. J Vasc Interv Radiol 2002; 13:625-9. [PMID: 12050304 DOI: 10.1016/s1051-0443(07)61658-3] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
An 80-year-old woman with established giant cell arteritis presented at the authors' institution with a 6.5-cm false aneurysm of the descending thoracic aorta complicated by focal dissection and intramural hematoma after a 1-week history of acute-onset chest pain. The patient underwent uncomplicated endovascular aortic repair with a 32-mm x 15-cm TagExcluder stent-graft. After the procedure, the intramural hematoma resolved and the patient's corticosteroid and immunosuppressive therapy was repeatedly adjusted. However, the giant cell arteritis activity relapsed after 8 months with development of a similar 1.5-cm false aneurysm below the thoracic stent-graft, complicated by focal intramural hematoma. Repeat uncomplicated thoracic stent-graft implantation was performed and CT follow-up displayed resorption of the intramural hematomas with no evidence of endoleak or any new aortic pathology. This report discusses the difficult management of patients with relapsing active aortic giant cell arteritis and the potential role for endovascular thoracic aortic repair.
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Affiliation(s)
- Christoph Engelke
- Department of Radiology, St. Georges Hospital, London, United Kingdom.
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Nader R, Mohr G, Sheiner NM, Tampieri D, Mendelson J, Albrecht S. Mycotic aneurysm of the carotid bifurcation in the neck: case report and review of the literature. Neurosurgery 2001; 48:1152-6. [PMID: 11334284 DOI: 10.1097/00006123-200105000-00041] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
OBJECTIVE AND IMPORTANCE Mycotic aneurysms of the extracranial carotid artery are rare and difficult to diagnose. A search of the world literature published since 1966 reveals at least six cases of mycotic carotid aneurysms due to a Salmonella septicemia. We present an exceptional case of mycotic pseudoaneurysm of the bifurcation of the carotid artery due to Salmonella septicemia and discuss the pathogenesis as well as various aspects of the diagnosis and surgical management. CLINICAL PRESENTATION A 68-year-old man presented in Poland with Salmonella sepsis; 1 month later, he was admitted to the emergency department of the Sir Mortimer B. Davis-Jewish General Hospital in Montreal with a bulky and pulsatile right cervical mass. An angiogram and a computed tomographic scan revealed a voluminous and partially thrombosed aneurysm the size of a tangerine originating from the posterior aspect of the carotid junction. INTERVENTION Balloon trapping was attempted at the Montreal Neurological Hospital. Subsequently, the patient developed a significant neurological deficit, which was quickly reversed by the administration of hypertensive, hypervolemic, and hemodilution therapy. Thereafter, the pseudoaneurysm was resected surgically, and the internal and external carotid arteries were sacrificed. Pathological examination of the excised specimen of the carotid junction revealed a pseudoaneurysm. Bacterial culture of the lesion showed growth of Salmonella. CONCLUSION The postoperative course was satisfactory except for laryngeal paralysis due to involvement of the vagus nerve. Four months later, a computed tomographic scan showed only small lacunae in both centra semiovale.
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Affiliation(s)
- R Nader
- Department of Neurosurgery, Sir Mortimer B. Davis-Jewish General Hospital, McGill University, Montreal, Quebec, Canada
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Nader R, Mohr G, Sheiner NM, Tampieri D, Mendelson J, Albrecht S. Mycotic Aneurysm of the Carotid Bifurcation in the Neck: Case Report and Review of the Literature. Neurosurgery 2001. [DOI: 10.1227/00006123-200105000-00041] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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Bemelman M, Donker DN, Ackerstaff RG, Moll FL. Bilateral extracranial aneurysm of the internal carotid artery--a case report. VASCULAR SURGERY 2001; 35:225-8. [PMID: 11452350 DOI: 10.1177/153857440103500311] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The authors report a case study of a 78-year-old man with a bilateral extracranial atherosclerotic aneurysm of the internal carotid artery. The patient was treated surgically with resection of the aneurysm and restoration of the flow with a polytetrafluoroethylene (PTFE) graft. The postoperative period was uneventful. Histologic tests demonstrated almost complete destruction of the elastin fibers. The potential hazards of an aneurysm of the internal carotid artery indicate that surgical treatment is warranted.
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Affiliation(s)
- M Bemelman
- Department of Vascular Surgery, St. Antonius Hospital, Koekoekslaan 1, 3435 CM Nieuwegein, the Netherlands.
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Patra P, Ricco JB, Costargent A, Goueffic Y, Pillet JC, Chaillou P. Infected aneurysms of neck and limb arteries: a retrospective multicenter study. Ann Vasc Surg 2001; 15:197-205. [PMID: 11265084 DOI: 10.1007/s100160010047] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
Infected aneurysms (IA) of neck and limb arteries are uncommon. This report describes the results of a retrospective study undertaken by the University Association for Surgical Research (AURC) to evaluate etiology, bacteriology, location, diagnostic features, and therapeutic methods associated with IA. A total of 58 IA in 52 patients were reviewed. The lesion was located in a lower extremity artery in 47 patients (81%), internal carotid artery in 7 (12%), and upper extremity artery in 4 (6%). Eleven patients had multilocular aneurysm (21%). Symptoms of local infection were observed in 43 patients (82.6%). Rupture or splitting was the presenting manifestation in 13 patients (25%). Primary IA following bacteremia or septicemia without endocarditis was the most common type of IA observed in 34 patients (65.3%). Twelve patients (23%) presented mycotic IA secondary to bacterial endocarditis. In the remaining six patients (11.5%), IA resulted from direct contamination or spreading from a contiguous infection site. Surgical treatment included ligation of the artery without reconstruction in 19 patients and exclusion bypass in 33 patients. The duration of antibiotic treatment ranged from 15 days to 3 months. No recurrence of aneurysm was observed but three patients developed bypass infection. Primary IA was associated with high mortality due to severe septicemia.
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Affiliation(s)
- P Patra
- Service de Chirurgie Vasculaire, Hôpital G. et R. Laënnec, C.H.U. de Nantes, Boulevard Jacques Monod, St Herblain 44093 Nantes, France.
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