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Case Reports
. 2018 Jan-Mar;8(1):48-51.
doi: 10.4103/IJCIIS.IJCIIS_62_17.

Right carotid-cutaneous fistula and right carotid pseudoaneurysm formation secondary to a chronically infected polyethylene terephthalate patch

W T Hillman Terzian  1 , Samuel Schadt  2 , Sharvil U Sheth  3
Affiliations
Case Reports

Right carotid-cutaneous fistula and right carotid pseudoaneurysm formation secondary to a chronically infected polyethylene terephthalate patch

W T Hillman Terzian et al. Int J Crit Illn Inj Sci. 2018 Jan-Mar.

Abstract

Carotid endarterectomy (CEA) remains the treatment for significant carotid stenosis and stroke prevention. Approximately 100,000 CEAs are performed in the United States every year. Randomized trials have demonstrated an advantage of patch carotid angioplasty over primary closure. Complications from patches include thrombosis, transient ischemic attack, stroke, restenosis, pseudoaneurysm (PA), and infection. PA after CEA is rare, with a reported average of 0.37% of cases. We describe an unusual case of PA after polyethylene terephthalate (PTFE) patching for CEA. An 88-year-old female with Alzheimer's disease living in a nursing facility with a history of skin cancer on her right chest developed a new area of intermittent brisk bleeding on her right neck which was initially believed to be related to her skin cancer. She had a remote history of right CEA with a PTFE patch approximately a decade ago. A computed tomography angiograph-head-and-neck with showed a partially thrombosed PA in the region of her right common carotid artery bifurcation with a tract containing gas and fluid extending to the skin surface suspicious for a partially thrombosed, leaking PA. She was taken urgently to the operating room on broad-spectrum antibiotics where we performed a right neck exploration, ligation of a bleeding carotid PA by ligation of the right common, internal, and external carotid arteries, explantation of a chronically infected polyethylene terephthalate patch, and closure with a sternocleidomastoid advanced flap with multilayered closure. She was discharged to her nursing facility with 6 weeks of ceftriaxone intravenous (IV) and metronidazole IV through a peripherally inserted central catheter (PICC) line with no neurological sequelae.

Keywords: Carotid artery endarterectomy; polyethylene terephthalate patch; pseudoaneurysm.

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Conflict of interest statement

There are no conflicts of interest.

Figures

Figure 1
Figure 1
Right neck wound with intermittent bleeding
Figure 2
Figure 2
Computed tomography angiograph showing partially thrombosed pseudoaneurysm with tract containing gas and fluid extending to the skin surface
Figure 3
Figure 3
Explanation of a chronically infected polyethylene terephthalate patch and a probe traversing a right carotid-cutaneous fistula
See this image and copyright information in PMC

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