Prosthetic patch infection after carotid endarterectomy

Objectives and design: prospective audit of tire management and outcome of prosthetic patch infection after carotid endarterectomy (CEA) at Leicester Royal Infirmary plus review of the literature. Results: 8/936 CEA patients (0.85%) developed a prosthetic patch infection. Responsible organisms included MRSA (n=3), Staphylococcus epidermidis (n=2), haemolytic Streptococcus (n=1), Staphylococcus aureus (n=1) and Pseudomonas (n=1). Early wound complications preceded 4/5 infections presenting within 9 weeks of surgery. In addition to systemic antibiotics and debridement, management included patch removal and: (l) carotid ligation (n=3), vein patch repair (n=1), vein bypass (n=3). One patient had antibiotic irrigation of the in-situ patch. No patient died, one suffered a disabling postoperative stroke and two had temporary cranial nerve injuries. Including this series, a literature review identified 43 prosthetic patch infections, 91% culturing Staphylococci or Streptococci. Cumulative freedom from perioperative stroke/death or re-infection was 65% at 2 years. Patients treated by patch excision rend autologous venous reconstruction had the best outcome with a cumulative freedom from perioperative stroke/death or reinfection of 91% at 2 years. Conclusions: prosthetic patch infection after CEA is rare. This study emphasises the importance of close surveillance of early wound complications. Surgical decision-Making, especially the safety of carotid ligation, was facilitated by access to transcranial Doppler.