Regarding "Dacron carotid patch infection: a report of eight cases"

Dacron Patch Infection after Carotid Endarterectomy: Case Report and Review of the Literature

Patch angioplasty of the carotid artery after endarterectomy is a widely utilized technique with potential benefits of perioperative and long-term stroke risk reduction as well as a decreased incidence of recurrent stenosis. One of the complications of using a synthetic material as a patch is the development of prosthetic patch infection. We present a case report of a patient who was treated at our institution with such a complication and review the literature on this rare occurrence. The risk factors, workup, diagnosis, and treatment of prosthetic patch infection are reviewed. Despite the serious nature of this problem, surgical treatment is associated with minimal morbidity and an acceptable postoperative mortality and stroke rate.

Postoperative infection associated with polyester patch angioplasty after carotid endarterectomy

OBJECTIVES

Postoperative infection is one of the most dreaded complications associated with use of synthetic patches for carotid endarterectomy. Although polyester patches were used extensively for carotid patch angioplasty throughout the last decade, few reports detail cases of deep patch infection. We describe our experience with polyester patch infections after carotid endarterectomy. Patients and methods From January 1996 through December 2001 we treated polyester patch infections after carotid endarterectomy in 10 patients.

RESULTS

The interval from primary carotid endarterectomy to presentation with infection ranged from 11 days to 30 months. All patients underwent repeat operation that involved tissue debridement, excision of the polyester patch, and either interposition grafting or patch angioplasty with autologous vein. No perioperative stroke or death occurred; however, 1 patient had transient hoarseness, and in 1 patient a pseudoaneurysm developed that required additional surgical repair with a saphenous vein interposition graft. All patients remain well and free of infection with follow-up as long as 56 months.

CONCLUSIONS

Infection is a serious and rare complication of carotid patch angioplasty with polyester material. Nonetheless, it can be treated successfully with good results and acceptable morbidity with soft tissue debridement, prosthetic patch excision, and either patch angioplasty or interposition grafting with autologous vein.

Nonvalvular Intravascular Device-related Infections

Nonvalvular intravascular devices are in widespread use in developed countries and are now more commonly employed than are prosthetic cardiac valves. Although the variety of devices that are included in the category of "nonvalvular" represent a heterogenous collection, there is commonality among several of the devices. This includes their requirement to sustain life and the need for removal for cure if they become infected, which is often due to multidrug-resistant microorganisms. Thus, infection of these devices often presents difficult treatment scenarios. This update will address the pathogenesis and immunobiology of nonvalvular intravascular device-related infections and the epidemiology and treatment of infections of several of these devices that include pacemakers, implantable cardioverter defibrillators, intravascular catheters, vascular grafts and stents, and left ventricular assist devices.