MYCOTIC EXTRACRANIAL CAROTID ARTERIES ANEURYSMS – SYSTEMATIC REVIEW OF THE LITERATURE
DOI:
https://doi.org/10.48750/acv.331Keywords:
Infected aneurysm, Carotid arteryAbstract
Introduction: Mycotic extracranial carotid artery aneurysms are extremely unusual, with only around 100 cases published in the literature. They represent a challenge due to delayed presentations, possible catastrophic consequences if left untreated, as well as high morbidity after surgical management. Knowledge about infectious aneurysms on this territory remains limited to case reports. Thus, the authors pretend to present a systematic review on the matter with the intention to open a path to further understanding.
Methods: Pubmed and Embase databases were consulted using the keywords “infected aneurysm” and “carotid artery”, including published papers in English to the present date. Papers in other languages and papers which focused results on intracranial locations of the disease were excluded. Pseudoaneurysms following trauma or vascular surgery were not included.
Results: Inclusion criteria allowed analysis of 55 papers from 1979-2019 reporting data on 58 patients. Median age was 63 years old (min. 9 months; max.88 years), being 67% male. Among diverse risk factors, nearly 70% presented a previous history of bacterial infection or immunosuppression. The right carotid arteries were affected in 52% of cases. The most usual location was the internal carotid artery (31 cases) followed by the common carotid, almost exclusively near the bifurcation in both groups. Clinical presentation was broad, including neck mass (46%), compression syndromes as Horner syndrome, dysphagia or hoarseness (38%); and stroke/transient ischemic attack (11%). The most common bacteria identified were Staphylococcus aureus (26%), followed by Salmonella spp (19%). Autologous vein graft interposition was the technique used to treat the majority of cases. Carotid ligation, occlusion using detachable coils and stent graft angioplasty were among the applied treatments. Mortality was reported in 7 patients (14%).
Conclusion: Mycotic carotid artery aneuryms are rare and demand surgical treatment. Diagnosis can be challenging due to late presentation of neck mass or compression syndromes. Treatment implies inflow restoration and removal of infected tissue, so interposition grafts using autologous conduits remain the preferred strategy. Although endovascular techniques can be used in selected cases, one should remember that prosthetic material can be a nidus for bacterial growth. Morbidity and mortality may be higher than expected due to publication bias.
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References
2. A. Shipley, N. Winslow e W. W., “Aneurysm of the cervical portion of the internal carotid artery: an analytical study of the cases recorded in the literature between August 1, 1925, and July 31, 1936: a report of two new cases.,” Annals of Surgery, vol. 105, pp. 673-699, 1937.
3. S. Brown, R. Busuttil, J. Baker e e. al., “Bacteriologic and surgical determinants of survival in patientes with mycotic aneurysms,” Journal of Vascular Surgery, vol. 1, pp. 541-547, 1984.
4. P. Patra, J. Ricco, A. Costargent e e. al, “Infected Aneurysms of Neck and Limb Arteries: A Retrospective Multicenter Study,” Annals of Vascular Surgery, pp. 197-205, 2001.
5. A. Reisner, G. Marshall, K. Bryant e e. al., “Endovascular occlusion of a carotid pseudoaneurysm complicating deep neck space infection in a child,” Journal of Neurosurgery, vol. 91, pp. 510-514, 1999.
6. D. Naik, N. Atkinson, P. Field e e. al., “Mycotic cervical carotid aneurysm,” Australia and New Zealand Journal of Surgery, vol. 65, pp. 620-621, 1995.
7. C. Riga, C. Bicknell, R. Jindall e e. al., “Endovascular Stenting of Peripheral Infected Aneurysms: A Temporary Measure or a Definitive Solution in High-Risk Patients,” Cardiovascular Interventional Radiology, vol. 31, pp. 1228-1235, 2008.
8. H. Rice, S. Arbabi, R. Kremer e e. al, “Ruptured Salmonella Mycotic Aneurysm of the extracranial carotid artery,” Annals of Vascular Surgery, vol. 11, pp. 416-419, 1997.
9. H. Constantinides, C. Passant e A. Waddell, “Mycotic pseudoaneurysm of common carotid artery mimicking parapharyngeal abscess,” Journal of Laryngology and Otology, vol. 114, 2000.
10. M. Lin, S. Chang, R. Wu e e. al., “Comparison of Computed Tomography, Magnetic Ressonance Imaging, and Digital Subtraction Angiography Findings in the Diagnosis of Infected Aortic Aneurysm,” Journal of Computed Assisted Tomography, vol. 32, pp. 616-620, 2008.
11. J. Champey, P. Pavese, H. Bouvaist e e. al, “Value of brain MRI in infective endocarditis: a narrative review,” European Journal of Clinical Microbiology and Infectious Diseases, vol. 35, pp. 159-168, 2016.
12. S. Wilson, P. v. Wagenen e E. Passaro, “Arterial infection,” Current Problems in Surgery, vol. 15, pp. 1-89, 1978.
13. G. Higgins, J. Sandiford e W. Blair, “Remote Salmonella infections,” World Journal of Surgery, vol. 6, pp. 236-240, 1982.
14. G. Oderich, J. Panneton, T. Bower e e. al., “Infected aortic aneurysms: Aggressive presentation, complicated early outcome, but durable results,” Journal of Vascular Surgery, vol. 5, pp. 900-908, 2001.
15. E. Lueg, D. Awerbuck e V. Forte, “Ligation of the common carotid artery for the management of a mycotic pseudoaneurysm of an extracranial internal carotid artery. A case report and review of the literature.,” International Journal of Pediatric Otorhinolaryngology, vol. 33, pp. 67-74, 1995.
16. W. Ehrnefeld, R. Stoney e W. E., “Relation of carotid stump pressure to safety of carotid artery ligation,” Surgery, vol. 93, pp. 299-305, 1938.
17. C. Glaiberman, R. Towbin e D. Boal, “Giant mycotic aneurysm of the internal carotid artery in a child: endovascular treatment,” Pediatric Radiology, vol. 33, pp. 211-215, 2003.
18. D. Angiletta, R. Pulli, D. Marinazzo e e. al, “Surgical and Endovascular Treatment of Extracranial Carotid Artery Aneurysms: Early and Long-Term Results of a Single Center,” Annals of Vascular Surgery, vol. 28, pp. 659-664, 2014.
19. A. Pirvu, C. Bouchet, F. Garibotti e e. al., “Mycotic aneurysm of the internal carotid artery,” Annals of Vascular Surgery, pp. 826-830, 2013.
20. S. Martens, R. Beelen e I. Degrieck, “Mycotic Aneurysm of the extracranial carotid artery: case report and review of the literature,” Ata Chirurgica Belgica, vol. 111, pp. 97-99, 2011.
21. H. Masumoto, M. Shimamoto, F. Yamazaki e e. al., “Airway stenosis associated with a mycotic pseudoaneurysm of the common carotid artery,” General Thoracic and Cardiovascular Surgery, vol. 56, pp. 242-245, 2008.
22. S. Lee, Y. Cho, J. Park e e. al., “Treatment of an acute mycotic aneurysm of the common carotid artery with a covered stent-graft,” Yonsei Medical Journal, vol. 53, pp. 224-227, 2012.
23. C. Ho, J. Lam e L. McAdory, “Carotid Mycotic Aneurysm associated with persistent primitive hypoglossal artery. Case report and literature review,” The Journal of Radiology Case Reports, vol. 13, pp. 1-7, 2019.
24. A. Romila, I. Mocanu, M. Chetrone e e. al., “Left common carotid artery ruptured mycotic aneurysm with ischaemic stroke in patient with myelodysplastic syndrome. A case report and literature review,” Ata Medica Mediterranea, vol. 34, pp. 449-452, 2018.
