The University of Kansas School of Medicine, Kansas City, Kansas, USA.
The University of Kansas School of Medicine, Kansas City, Kansas, USA.
World Neurosurg. 2022 Nov;167:131-146. doi: 10.1016/j.wneu.2022.08.124. Epub 2022 Sep 2.
The goal of this study was to systematically review the management and outcomes of patients who developed pseudoaneurysm (PA) after carotid endarterectomy (postendarterectomy PA [PEPA]).
Following the PRISMA guidelines, a systematic literature review was performed using PubMed, Scopus, and Web of Science databases from date of inception to June 2022. Studies were selected based on predetermined inclusion and exclusion criteria. Simultaneously, a retrospective review was conducted of patients who underwent neurosurgical evaluation of suspected PEPA at our institution.
Of the 321 articles in the original literature search, 62 were selected. A total of 143 patients (93 men, 27 women; mean age, 70.7 years) diagnosed with PEPA were included. Mean time from carotid endarterectomy to PA diagnosis was 41.8 months. Primary repair data were available for 135 patients, including 19 with primary closures, 112 with patch or graft repairs, and 4 with eversion procedures. Fifty-five patients with PA (39%) presented with infection. Staphylococcal species were the most common causative organism. Of infected PAs, 89.1% were treated with open procedures. Overall complication rates of PAs treated via open, endovascular, and hybrid methods were 31%, 15.4%, and 0%, respectively. Open ligation (42.9%) and aneurysmectomy with grafting (36.4%) resulted in the highest rates of complications.
Despite higher complication rates after open repair strategies, use of these techniques remains a viable option in situations requiring removal of infected patches or evacuation of large extravascular collections. Endovascular treatment options are associated with low numbers of complications and can be considered for primary PEPA treatment when infection is not present.
本研究旨在系统回顾颈动脉内膜切除术（颈动脉内膜切除术后假性动脉瘤[PEPA]）后发生假性动脉瘤（PA）患者的治疗和结局。
根据 PRISMA 指南，使用 PubMed、Scopus 和 Web of Science 数据库，从创建日期到 2022 年 6 月进行系统文献回顾。研究根据预先确定的纳入和排除标准进行选择。同时，对在我院接受疑似 PEPA 神经外科评估的患者进行回顾性研究。
原始文献检索中共有 321 篇文章，其中 62 篇被选中。共纳入 143 例（93 例男性，27 例女性；平均年龄 70.7 岁）PEPA 患者。从颈动脉内膜切除术到 PA 诊断的平均时间为 41.8 个月。共有 135 例患者的主要修复数据可用，其中 19 例采用直接修复，112 例采用补片或移植物修复，4 例采用外翻术。55 例 PA（39%）合并感染。葡萄球菌属是最常见的致病病原体。感染性 PA 中，89.1%采用开放手术治疗。采用开放、血管内和杂交方法治疗 PA 的总体并发症发生率分别为 31%、15.4%和 0%。开放结扎（42.9%）和动脉瘤切除术加移植（36.4%）导致的并发症发生率最高。
尽管开放修复策略的并发症发生率较高，但在需要去除感染性补片或清除大的血管外积血时，这些技术仍然是可行的选择。血管内治疗选择并发症较少，当不存在感染时，可考虑用于原发性 PEPA 治疗。
