Carotid Artery Pseudoaneurysm Following Carotid Endarterectomy: Cases Report and Literatures Review_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

 DIAOYong-peng , CHENYue-xin , ZENGRong , YANSheng , CHENZuo-guan ,  LIYong-jun.

Department of Vascular Surgery, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Science, Beijing 100730, China;

Corresponding author：

LIYong-jun., Email: yongj_93@hotmail.com

Keywords：

Pseudoaneurysm; Carotid endarterectomy; Carotid artery stenosis

DOI：

10.7507/1007-9424.20150161

Video：

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Objective To summarize the etiology and prevention measures of carotid artery pseudoaneurysms following carotid endarterectomy (CEA) and discuss the complications and prognosis of it performed surgery and endovascular treatment. Methods The process and experience of diagnosis and treatment of two patients with carotid pseudoaneurysm following CEA admitted in this hospital from January 2000 to March 2014 were analyzed retrospectively. The related English literatures concerning carotid artery pseudoaneurysm following CEA in PubMed, SpringerLink, ELSEVIER, and ScienceDirect database were searched and then made a conclusion. Results ①The incidence of carotid artery pseudoaneurysms following CEA in this hospital was 0.31% (2/641). These two patients were treated with surgery and endovascular therapy respectively, and both recovered well after the treatment.②Thirty-nine related literatures totally were collected, including 187 patients with carotid artery pseudoaneurysm. One hundred and forty patients were treated with artificial patches during CEA, and 36 patients suffered secondary infection in the surgical sites. One hundred and fifty-two patients were treated with surgery, while 33 patients were treated with endovascular therapy, the residual two patients were accepted hybrid surgery. The overall incidence of cranial nerve injuries, the incidence of 30-day stroke, and the incidence of 30-day mortality were 6.4% (9/141), 7.4% (12/163), and 2.7% (5/182), respectively. Conclusions Surgical site infection is one of the important reasons which lead to carotid artery pseudoaneurysm following CEA. Aneurysm resection and carotid artery reconstruction is still the main treatment of the carotid artery pseudoaneurysm; endovascular therapy could be used as a choice for a part of the patients. How to reduce the perioperative cranial nerve damage and the incidence of complications such as stroke still need further to be studied.

Citation： DIAOYong-peng, CHENYue-xin, ZENGRong, YANSheng, CHENZuo-guan, LIYong-jun.. Carotid Artery Pseudoaneurysm Following Carotid Endarterectomy: Cases Report and Literatures Review. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2015, 22(5): 618-622. doi: 10.7507/1007-9424.20150161 Copy

1.	Ahuja V, Tefera G. Successful covered stent-graft exclusion of carotid artery pseudo-aneurysm:Two case reports and review of literature. Ann Vasc Surg, 2007, 21(3):367-372.
2.	Weber SS, Annenberg AJ, Wright CB, et al. Early pseudoaneurysm degeneration in biologic extracellular matrix patch for carotid repair. J Vasc Surg, 2014, 59(4):1116-1118.
3.	Angiletta D, Pulli R, Marinazzo DA, et al. Surgical and endovascular treatment of extracranial carotid artery aneurysms:early and longterm results of a single center. Ann Vasc Surg, 2014, 28(3):659-664.
4.	Menna D, Ruggiero M, Speziale F. Infected pseudoaneurysm after carotid endarterectomy:mismatch between clinical presentation and origin. Ann Vasc Surg, 2014, 28(3):740.e17-e19.
5.	Pulli R, Dorigo W, Alessi Innocenti A, et al. A 20-year experience with surgical management of true and false internal carotid artery aneurysms. Eur J Vasc Endovasc Surg, 2013, 45(1):1-6.
6.	Pulli R, Dorigo W, Pratesi G, et al. Single-center experience on endovascular repair of noninfected extracranial internal carotid artery pseudoaneurysms. Ann Vasc Surg, 2013, 27(5):e13-e17.
7.	Nordanstig J, Gelin J, Jensen N, et al. National experience with extracranial carotid artery aneurysms:epidemiology, surgical treatment strategy, and treatment outcome. Ann Vasc Surg, 2014, 28(4):882-886.
8.	Dahya V, Chalasani P. Successful obliteration of a pseudoaneurysm from post-CEA repair secondary to a pruitt-inahara shunt using a stent graft. Case Rep Vasc Med, 2013, 2013:382485.
9.	Kovacevic P, Velicki L, Ivanovic V, et al. Carotid-carotid bypass as an option in the treatment of infected pseudoaneurysm after prosthetic carotid replacement. Ann Vasc Surg, 2013, 27(2):239. e13-e16.
10.	Carnini M, Piffaretti G, Lomazzi C. Stent-graft repair of carotid endarterectomy-related pseudoaneurysm. J Acute Dis, 2013, 2(1):61-65.
11.	Garg K, Rockman CB, Lee V, et al. Presentation and management of carotid artery aneurysms and pseudoaneurysms. J Vasc Surg, 2012, 55(6):1618-1622.
12.	Mann CD, McCarthy M, Nasim A, et al. Management and outcome of prosthetic patch infection after carotid endarterectomy:a singlecentre series and systematic review of the literature. Eur J Vasc Endovasc Surg, 2012, 44(1):20-26.
13.	Defillo A, Zelensky A, Pulivarthi S, et al. Non-infected carotid artery pseudoaneurysm 29 years after endarterectomy, endovascular management with covered stent. J Neurosurg Sci, 2012, 56(2):145-149.
14.	Moghadam SP, Kumar S, Fisher RK, et al. Carotid artery pseudoaneurysm after carotid endarterectomy and bovine pericardial patch angioplasty:case report. EJVES Extra, 2011, 22(6):e67-e69.
15.	Naughton PA, Garcia-Toca M, Rodriguez HE, et al. Carotid artery Reconstruction for infected carotid patches. Eur J Vasc Endovasc Surg, 2010, 40(4):492-498.
16.	Srivastava SD, Eagleton MJ, O'hara P, et al. Surgical repair of carotid artery aneurysms:a 10-year, single-center experience. Ann Vasc Surg, 2010, 24(1):100-105.
17.	Harrison G, McWilliams R, Fisher R. Endovascular treatment of an infected carotid prosthetic patch and pseudo-aneurysm. EJVES Extra, 2010, 20(4):e27-e29.
18.	Baker AC, Arko FR, Zarins CK, et al. Management of a chronic carotid artery pseudoaneurysm. Vasc Endovascular Surg, 2010, 44(1):61-63.
19.	Troutman DA, Mohan CR, Samhouri FA, et al. Endovascular repair of carotid artery pseudoaneurysm after carotid endarterectomy with self-expanding covered stents-a long-term follow-up. Ann Vasc Surg, 2010, 24(7):954.e13-e16.
20.	Donas KP, Schulte S, Pitoulias GA, et al. Surgical outcome of degenerative versus postreconstructive extracranial carotid artery aneurysms. J Vasc Surg, 2009, 49(1):93-98.
21.	Abdelhamid MF, Wall ML, Vohra RK. Carotid artery pseudoaneurysm after carotid endarterectomy:case series and a review of the literature. Vasc Endovascular Surg, 2009, 43(6):571-577.
22.	Attigah N, Külkens S, Zausig N, et al. Surgical therapy of extracranial carotid artery aneurysms:long-term results over a 24-year period. Eur J Vasc Endovasc Surg, 2009, 37(2):127-133.
23.	Briguori C, Selvetella L, Baldassarre MP. Endovascular repair of a carotid pseudoaneurysm with fluency plus stent graft implantation. J Invasive Cardiol, 2007, 19(9):e254-e257.
24.	De Filippo CM, Modugno P, Nasso G, et al. Pseudoaneurysm after patch-free carotid bifurcation endarterectomy:a case report. Vasc Endovascular Surg, 2007, 41(5):448-451.
25.	Litwinski RA, Wright K, Pons P. Pseudoaneurysm formation following carotid endarterectomy:Two case reports and a literature review. Ann Vasc Surg, 2006, 20(5):678-680.
26.	Szopinski P, Ciostek P, Kielar M, et al. A series of 15 patients with extracranial carotid artery aneurysms:surgical and endovascular treatment. Eur J Vasc Endovasc Surg, 2005, 29(3):256-261.
27.	Martin ND, Carabasi RA, Bonn J, et al. Endovascular repair of carotid artery aneurysms following carotid endarterectomy. Ann Vasc Surg, 2005, 19(6):913-916.
28.	Mousa A, Bernheim J, Lyon R, et al. Postcarotid endarterectomy pseudoaneurysm treated with combined stent graft and coil embolization. Vasc Endovascular Surg, 2005, 39(2):191-194.
29.	Yasuda H, Kuroda S, Ushikoshi S, et al. Combined surgical and endovascular treatment of infected pseudoaneurysm after carotid endarterectomy. Case report. Neurol Med Chir (Tokyo), 2005, 45(1):37-40.
30.	Baril DT, Ellozy SH, Carroccio A, et al. Endovascular repair of an infected carotid artery pseudoaneurysm. J Vasc Surg, 2004, 40(5):1024-1027.
31.	McCready RA, Divelbiss JL, Bryant MA, et al. Endoluminal repair of carotid artery pseudoaneurysms:A word of caution. J Vasc Surg, 2004, 40(5):1020-1023.
32.	Grant AA, Gray BH. Common carotid pseudoaneurysm after carotid endarterectomy:a case presentation. Vasc Med, 2004, 9(2):129-131.
33.	Gupta K, Dougherty K, Hermman H, et al. Endovascular repair of a giant carotid pseudoaneurysm with the use of Viabahn stent graft. Catheter Cardiovasc Interv, 2004, 62(1):64-68.
34.	Borazjani BH, Wilson SE, Fujitani RM, et al. Postoperative complications of carotid patching:pseudoaneurysm and infection. Ann Vasc Surg, 2003, 17(2):156-161.
35.	Terramani TT, Workman MJ, Loberman Z, et al. Adjunctive endovascular techniques in the management of postoperative carotid artery pseudoaneurysms-useful armamentarium for vascular surgeons-three case reports. Vasc Endovascular Surg, 2003, 37(3):207-212.
36.	Hertz JA, Minion DJ, Quick RC, et al. Endovascular exclusion of a postendarterectomy carotid pseudoaneurysm. Ann Vasc Surg, 2003, 17(5):558-561.
37.	Lin PH, Bush RL, Lumsden AB. Successful stent-graft exclusion of a bovine patch-related carotid artery pseudoaneurysm. J Vasc Surg, 2003, 38(2):396.
38.	El-Sabrout R, Cooley DA. Extracranial carotid artery aneurysms:Texas Heart Institute experience. J Vasc Surg, 2000, 31(4):702-712.
39.	McCollum CH, Wheeler WG, Noon GP, et al. Aneurysms of the extracranial carotid artery. Twenty-one years' experience. Am J Surg, 1979, 137(2):196-200.
40.	Rosset E, Albertini JN, Magnan PE, et al. Surgical treatment of extracranial internal carotid artery aneurysms. J Vasc Surg, 2000, 31(4):713-723.
41.	Zhou W, Lin PH, Bush RL, et al. Carotid artery aneurysm:Evolution of management over two decades. J Vasc Surg, 2006, 43(3):493-496.
42.	Li Z, Chang G, Yao C, et al. Endovascular stenting of extracranial carotid artery aneurysm:a systematic review. Eur J Vasc Endovasc Surg, 2011, 42(4):419-426.

1. Ahuja V, Tefera G. Successful covered stent-graft exclusion of carotid artery pseudo-aneurysm:Two case reports and review of literature. Ann Vasc Surg, 2007, 21(3):367-372.
2. Weber SS, Annenberg AJ, Wright CB, et al. Early pseudoaneurysm degeneration in biologic extracellular matrix patch for carotid repair. J Vasc Surg, 2014, 59(4):1116-1118.
3. Angiletta D, Pulli R, Marinazzo DA, et al. Surgical and endovascular treatment of extracranial carotid artery aneurysms:early and longterm results of a single center. Ann Vasc Surg, 2014, 28(3):659-664.
4. Menna D, Ruggiero M, Speziale F. Infected pseudoaneurysm after carotid endarterectomy:mismatch between clinical presentation and origin. Ann Vasc Surg, 2014, 28(3):740.e17-e19.
5. Pulli R, Dorigo W, Alessi Innocenti A, et al. A 20-year experience with surgical management of true and false internal carotid artery aneurysms. Eur J Vasc Endovasc Surg, 2013, 45(1):1-6.
6. Pulli R, Dorigo W, Pratesi G, et al. Single-center experience on endovascular repair of noninfected extracranial internal carotid artery pseudoaneurysms. Ann Vasc Surg, 2013, 27(5):e13-e17.
7. Nordanstig J, Gelin J, Jensen N, et al. National experience with extracranial carotid artery aneurysms:epidemiology, surgical treatment strategy, and treatment outcome. Ann Vasc Surg, 2014, 28(4):882-886.
8. Dahya V, Chalasani P. Successful obliteration of a pseudoaneurysm from post-CEA repair secondary to a pruitt-inahara shunt using a stent graft. Case Rep Vasc Med, 2013, 2013:382485.
9. Kovacevic P, Velicki L, Ivanovic V, et al. Carotid-carotid bypass as an option in the treatment of infected pseudoaneurysm after prosthetic carotid replacement. Ann Vasc Surg, 2013, 27(2):239. e13-e16.
10. Carnini M, Piffaretti G, Lomazzi C. Stent-graft repair of carotid endarterectomy-related pseudoaneurysm. J Acute Dis, 2013, 2(1):61-65.
11. Garg K, Rockman CB, Lee V, et al. Presentation and management of carotid artery aneurysms and pseudoaneurysms. J Vasc Surg, 2012, 55(6):1618-1622.
12. Mann CD, McCarthy M, Nasim A, et al. Management and outcome of prosthetic patch infection after carotid endarterectomy:a singlecentre series and systematic review of the literature. Eur J Vasc Endovasc Surg, 2012, 44(1):20-26.
13. Defillo A, Zelensky A, Pulivarthi S, et al. Non-infected carotid artery pseudoaneurysm 29 years after endarterectomy, endovascular management with covered stent. J Neurosurg Sci, 2012, 56(2):145-149.
14. Moghadam SP, Kumar S, Fisher RK, et al. Carotid artery pseudoaneurysm after carotid endarterectomy and bovine pericardial patch angioplasty:case report. EJVES Extra, 2011, 22(6):e67-e69.
15. Naughton PA, Garcia-Toca M, Rodriguez HE, et al. Carotid artery Reconstruction for infected carotid patches. Eur J Vasc Endovasc Surg, 2010, 40(4):492-498.
16. Srivastava SD, Eagleton MJ, O'hara P, et al. Surgical repair of carotid artery aneurysms:a 10-year, single-center experience. Ann Vasc Surg, 2010, 24(1):100-105.
17. Harrison G, McWilliams R, Fisher R. Endovascular treatment of an infected carotid prosthetic patch and pseudo-aneurysm. EJVES Extra, 2010, 20(4):e27-e29.
18. Baker AC, Arko FR, Zarins CK, et al. Management of a chronic carotid artery pseudoaneurysm. Vasc Endovascular Surg, 2010, 44(1):61-63.
19. Troutman DA, Mohan CR, Samhouri FA, et al. Endovascular repair of carotid artery pseudoaneurysm after carotid endarterectomy with self-expanding covered stents-a long-term follow-up. Ann Vasc Surg, 2010, 24(7):954.e13-e16.
20. Donas KP, Schulte S, Pitoulias GA, et al. Surgical outcome of degenerative versus postreconstructive extracranial carotid artery aneurysms. J Vasc Surg, 2009, 49(1):93-98.
21. Abdelhamid MF, Wall ML, Vohra RK. Carotid artery pseudoaneurysm after carotid endarterectomy:case series and a review of the literature. Vasc Endovascular Surg, 2009, 43(6):571-577.
22. Attigah N, Külkens S, Zausig N, et al. Surgical therapy of extracranial carotid artery aneurysms:long-term results over a 24-year period. Eur J Vasc Endovasc Surg, 2009, 37(2):127-133.
23. Briguori C, Selvetella L, Baldassarre MP. Endovascular repair of a carotid pseudoaneurysm with fluency plus stent graft implantation. J Invasive Cardiol, 2007, 19(9):e254-e257.
24. De Filippo CM, Modugno P, Nasso G, et al. Pseudoaneurysm after patch-free carotid bifurcation endarterectomy:a case report. Vasc Endovascular Surg, 2007, 41(5):448-451.
25. Litwinski RA, Wright K, Pons P. Pseudoaneurysm formation following carotid endarterectomy:Two case reports and a literature review. Ann Vasc Surg, 2006, 20(5):678-680.
26. Szopinski P, Ciostek P, Kielar M, et al. A series of 15 patients with extracranial carotid artery aneurysms:surgical and endovascular treatment. Eur J Vasc Endovasc Surg, 2005, 29(3):256-261.
27. Martin ND, Carabasi RA, Bonn J, et al. Endovascular repair of carotid artery aneurysms following carotid endarterectomy. Ann Vasc Surg, 2005, 19(6):913-916.
28. Mousa A, Bernheim J, Lyon R, et al. Postcarotid endarterectomy pseudoaneurysm treated with combined stent graft and coil embolization. Vasc Endovascular Surg, 2005, 39(2):191-194.
29. Yasuda H, Kuroda S, Ushikoshi S, et al. Combined surgical and endovascular treatment of infected pseudoaneurysm after carotid endarterectomy. Case report. Neurol Med Chir (Tokyo), 2005, 45(1):37-40.
30. Baril DT, Ellozy SH, Carroccio A, et al. Endovascular repair of an infected carotid artery pseudoaneurysm. J Vasc Surg, 2004, 40(5):1024-1027.
31. McCready RA, Divelbiss JL, Bryant MA, et al. Endoluminal repair of carotid artery pseudoaneurysms:A word of caution. J Vasc Surg, 2004, 40(5):1020-1023.
32. Grant AA, Gray BH. Common carotid pseudoaneurysm after carotid endarterectomy:a case presentation. Vasc Med, 2004, 9(2):129-131.
33. Gupta K, Dougherty K, Hermman H, et al. Endovascular repair of a giant carotid pseudoaneurysm with the use of Viabahn stent graft. Catheter Cardiovasc Interv, 2004, 62(1):64-68.
34. Borazjani BH, Wilson SE, Fujitani RM, et al. Postoperative complications of carotid patching:pseudoaneurysm and infection. Ann Vasc Surg, 2003, 17(2):156-161.
35. Terramani TT, Workman MJ, Loberman Z, et al. Adjunctive endovascular techniques in the management of postoperative carotid artery pseudoaneurysms-useful armamentarium for vascular surgeons-three case reports. Vasc Endovascular Surg, 2003, 37(3):207-212.
36. Hertz JA, Minion DJ, Quick RC, et al. Endovascular exclusion of a postendarterectomy carotid pseudoaneurysm. Ann Vasc Surg, 2003, 17(5):558-561.
37. Lin PH, Bush RL, Lumsden AB. Successful stent-graft exclusion of a bovine patch-related carotid artery pseudoaneurysm. J Vasc Surg, 2003, 38(2):396.
38. El-Sabrout R, Cooley DA. Extracranial carotid artery aneurysms:Texas Heart Institute experience. J Vasc Surg, 2000, 31(4):702-712.
39. McCollum CH, Wheeler WG, Noon GP, et al. Aneurysms of the extracranial carotid artery. Twenty-one years' experience. Am J Surg, 1979, 137(2):196-200.
40. Rosset E, Albertini JN, Magnan PE, et al. Surgical treatment of extracranial internal carotid artery aneurysms. J Vasc Surg, 2000, 31(4):713-723.
41. Zhou W, Lin PH, Bush RL, et al. Carotid artery aneurysm:Evolution of management over two decades. J Vasc Surg, 2006, 43(3):493-496.
42. Li Z, Chang G, Yao C, et al. Endovascular stenting of extracranial carotid artery aneurysm:a systematic review. Eur J Vasc Endovasc Surg, 2011, 42(4):419-426.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Carotid Artery Pseudoaneurysm Following Carotid Endarterectomy: Cases Report and Literatures Review

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