El-Sabrout R, Reul G, Cooley D A
Department of Cardiovascular Surgery, Texas Heart Institute at St. Luke's Episcopal Hospital, Houston, TX 77225, USA.
Ann Vasc Surg. 2000 May;14(3):239-47. doi: 10.1007/s100169910041.
The development of infected pseudoaneurysms (PAs) following carotid endarterectomy (CEA) is extremely rare. We retrospectively reviewed the data from 13 such aneurysms (in 12 patients) repaired over a period of 35 years at the Texas Heart Institute (THI) and included an overview of published cases to analyze the epidemiology, mode of presentation, methods of repair, and outcome. The diagnosis of PA should be considered when a patient develops a persistent hematoma, recurrent bleeding from the wound, or late wound infection. Sepsis is occasionally a presenting symptom. Surgical therapy for infected PAs can be challenging; excision of the aneurysm followed by autologous grafting constitutes the favored approach. Traditionally, Dacron patch repair has been associated with a high incidence of reinfection. Carotid artery ligation is required in a large percentage of cases (22.7%) and is associated with a prohibitive rate of death/major stroke (50%) compared with a low (12%) risk following arterial reconstruction. Prevention and early diagnosis of infected PAs are essential to limit complications and mortality.
颈动脉内膜切除术（CEA）后感染性假性动脉瘤（PA）的发生极为罕见。我们回顾性分析了德克萨斯心脏研究所（THI）35年间收治的12例患者的13例此类动脉瘤修复数据，并对已发表病例进行综述，以分析其流行病学、临床表现方式、修复方法及预后。当患者出现持续性血肿、伤口反复出血或晚期伤口感染时，应考虑PA的诊断。脓毒症偶尔也会作为首发症状出现。感染性PA的手术治疗颇具挑战性；动脉瘤切除后自体移植是首选方法。传统上，涤纶补片修复术后再感染发生率较高。大部分病例（22.7%）需要进行颈动脉结扎，与动脉重建术后较低的死亡/重大卒中风险（12%）相比，颈动脉结扎相关的死亡/重大卒中发生率高达50%。预防和早期诊断感染性PA对于限制并发症和死亡率至关重要。
