Pseudoaneurysm formation following carotid endarterectomy: two case reports and a literature review.

Arterial pseudoaneurysms lack all three layers of the arterial wall and are therefore prone to enlargement. They are common after injuries to the artery in the form of blunt trauma, puncture, or prior surgery. They present frequently with swelling, pain, thrombosis, and rupture and occasionally with infection. Options for repair include primary arteriorrhaphy, partial excision with patch angioplasty, and total excision with interposition grafting. We present two cases of pseudoaneurysm following carotid endarterectomy: one with infection, and one with sterile enlargement. A review of the literature suggests that pseudoaneurysm formation following carotid endarterectomy is an uncommon event, and infection of these lesions is even less likely. There appears to be no difference in incidence whether or not the patient had closure of the arteriotomy with a patch angioplasty. The principles of repair include removal of all infected tissue, reconstruction with autogenous vein if possible, and vascularized flap coverage.