Atherosclerotic Aneurysms Following Carotid Endarterectomy with Dacron Patch Angioplasty: An Unreported Complication

The authors report 4 atherosclerotic extracranial carotid aneurysms (AECA) in 3 patients who had carotid endarterectomies with Dacron patch angioplasty (CEADP). This complication has not previously been reported with this patch material in this location. These AECAs were found in a group of 204 patients. Two hundred thirty-two arteries (1.7%) who had CEADP and who returned for regular follow-up from 3 months to 15 years postoperatively. Three aneurysms were excised after angiographic confirmation and replaced with autologous saphenous vein interposition grafts uneventfully. One of the three patients who had bilateral CEADP has since developed a contralateral aneurysm presumed to be an AECA but has refused angiography and surgery. This aneurysm remained essentially unchanged for two years after detection. The patient was then lost to follow-up. The diagnosis of AECA in the patients who were operated on was confirmed by histology. Dacron patch angioplasty as an adjunct to carotid endarterectomy is an accepted technique which yields satisfactory results. This report however, cautions about a significant complication which occurs late in the postoperative course of patients who have had this procedure.