Pseudoaneurysm after carotid endarterectomy.

An unusual case of recurrent infected pseudoaneurysm seven years following carotid endarterectomy is described. The initial pseudoaneurysm was treated with resection and Dacron patch angioplasty. Recurrence one year later was caused by infection of the patch. Treatment with resection and autologous saphenous vein patch angioplasty resulted in cure. Pseudoaneurysm formation after carotid endarterectomy is unusual and can generally be traced to technical factors. Of the fifty reported cases, only seven (14%) resulted from or were associated with local infection. Avoidance of prosthetic patch material may help prevent this complication. If it does occur, management should include precise angiographic diagnosis, vascular control through previously unoperated areas, complete debridement of all necrotic and infected pseudocapsule, and, if necessary, reconstruction with autologous vein.