Chronic carotid patch infection masquerading as recurrent head/neck cancer treated with saphenous interposition bypass

Abstract

About 0.5–1 % of patients undergoing carotid endarterectomy (CEA) with patch repairs develop patch infections. This is the case of an 81-year-old woman with a past surgical history of right parotidectomy (thirty years ago) and right CEA (three years ago) who presented with a 3 × 4 cm right neck mass with intermittent drainage and bleeding. Fine needle aspiration biopsy was notable for pleomorphic adenoma and imaging demonstrated a mass in the parotid bed. Cultures of the discharge were negative for bacterial growth. However, in the OR, the patient was found to have an infected carotid patch. The case report describes patch excision and interposition bypass using greater saphenous vein.

Although the incidence of CEA patch infections is low, clinicians dealing with this pathology should have a high index of suspicion in patients presenting with an ipsilateral neck mass that bleeds intermittently. Patch infection may not be able to be ruled out even in the setting of negative culture data and biopsy results. Saphenous vein is an excellent conduit for repair and can be used with a shunt to maintain perfusion to the brain while the repair is performed.