Department of Surgery No. 2, The Danylo Halytsky National Medical University, Pekarska st 69, Lviv, 79010, Ukraine.
Chief Vascular Surgeon for the Military Forces of Ukraine, National Military Medical Clinical Center of the Ministry of Defense of Ukraine, Hospitalna st 16, Kiev, 01133, Ukraine.
J Med Case Rep. 2024 Oct 31;18(1):531. doi: 10.1186/s13256-024-04874-9.
Anastomotic pseudoaneurysms of interposition vein grafts are a rare entity that requires urgent management to prevent life-threatening complications, such as rupture and thromboembolism, especially when involving the carotid arteries. As these are rare complications and literature is sparse, we believe that this case report can aid the decision-making process in similar circumstances.
A 49-year-old Ukrainian male patient presented with a false aneurysm of both distal and proximal anastomosis of an interposition vein graft between the common carotid artery and the internal carotid artery, which was previously performed as a bailout procedure after the patient developed a complication of carotid surgery. The patient was successfully treated with extra-anatomical interposition of a vein graft from the subclavian artery to the remnant of extracranial internal carotid artery and en bloc excision of the previous vein graft with the false aneurysms.
Mycotic anastomotic pseudoaneurysms following carotid endarterectomy represent a rare yet serious complication in vascular surgery that requires urgent treatment. While endovascular techniques could represent an alternative option, open surgical repair is still the standard of care for this pathology, offering advantages in preventing postoperative ischemic complications and ensuring optimal long-term outcomes. The open approach provides direct visualization of the pseudoaneurysm. It allows the meticulous debridement of the infected tissues and an accurate reconstruction of the arterial wall with autologous or synthetic grafts. In light of the substantial evidence supporting its superiority, open surgical repair should remain the preferred approach in addressing mycotic anastomotic pseudoaneurysms following carotid endarterectomy. Future research should continue to explore advancements in other surgical techniques and refine treatment strategies to enhance patient outcomes in this challenging clinical scenario.
静脉移植物吻合口假性动脉瘤是一种罕见的实体，需要紧急处理，以防止危及生命的并发症，如破裂和血栓栓塞，特别是当涉及颈动脉时。由于这些是罕见的并发症，文献也很少，我们认为这个病例报告可以帮助在类似情况下做出决策。
一名 49 岁的乌克兰男性患者，因颈总动脉和颈内动脉之间的静脉移植物吻合口远端和近端假性动脉瘤而就诊，该患者之前曾因颈动脉手术后出现并发症而进行过静脉移植物桥接修复。患者成功地接受了来自锁骨下动脉至颅外颈内动脉残端的静脉移植物的解剖外桥接，并整块切除了先前带有假性动脉瘤的静脉移植物。
颈动脉内膜切除术（CEA）后吻合口感染性假性动脉瘤是血管外科中一种罕见但严重的并发症，需要紧急治疗。虽然血管内技术可能是一种替代选择，但开放手术修复仍然是这种病理的标准治疗方法，具有预防术后缺血性并发症和确保最佳长期效果的优势。开放方法可以直接观察假性动脉瘤。它可以彻底清除感染组织，并使用自体或合成移植物准确重建动脉壁。鉴于大量证据支持其优越性，在处理 CEA 后吻合口感染性假性动脉瘤时，开放手术修复应仍然是首选方法。未来的研究应继续探索其他手术技术的进展，并完善治疗策略，以提高这一具有挑战性的临床情况下的患者预后。
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