Illuminati Giulio, Calio' Francesco G, D'Urso Antonio, Ceccanei Gianluca, Pacilè Maria Antonietta
Francesco Durante Department of Surgery, University of Rome La Sapienza, Rome, Italy.
Ann Vasc Surg. 2009 Nov-Dec;23(6):786.e1-5. doi: 10.1016/j.avsg.2009.08.003.
We report on a 58-year-old male who presented with an enlarging cervical hematoma 3 months following carotid endarterectomy with Dacron patch repair, due to septic disruption of the Dacron patch secondary to presumed infection. The essential features of this case are the control of the proximal common carotid artery gained through a median sternotomy, because the patient was markedly obese with minimal thyromental distance, and the treatment consisting of in situ polytetrafluoroethylene bypass grafting, due to the absence of a suitable autogenous saphenous vein. Median sternotomy is rarely required in case of reintervention for septic false aneurysms and hematomas following carotid endarterectomy but should be considered whenever difficult control of the common carotid artery, when entering the previous cervicotomy, is anticipated. In situ polytetrafluoroethylene grafting can be considered if autogenous vein material is lacking.
我们报告了一名58岁男性，他在接受颈动脉内膜切除术并使用涤纶补片修复3个月后，出现颈部血肿增大，原因是推测感染导致涤纶补片发生感染性破裂。该病例的关键特征包括：由于患者极度肥胖且颏下距离极小，通过正中胸骨切开术控制近端颈总动脉；由于缺乏合适的自体大隐静脉，治疗方法为原位聚四氟乙烯旁路移植术。在颈动脉内膜切除术后因感染性假性动脉瘤和血肿进行再次干预时，很少需要正中胸骨切开术，但如果预计进入先前的颈部切口时难以控制颈总动脉，则应考虑采用。如果缺乏自体静脉材料，可以考虑原位聚四氟乙烯移植术。
