O065 Mycotic extracranial carotid artery aneurysms: a systematic review

Abstract

Abstract Introduction Mycotic extracranial carotid artery aneurysms are rare and their management variable due to a lack of evidence assessing outcomes. We undertook a systematic literature review to assess this. Methods Following PRIMSA guidelines, MEDLINE and EMBASE databases were searched for all cases of extracranial carotid artery aneurysms between January 1970 and March 2021. The search terms used were infect, abscess, mycotic, carotid, aneurysm, pseudoaneurysm. Aneurysm, infected and carotid artery disease” subject headings were used. Titles and abstracts were screened before full text papers were reviewed. Results 193 such aneurysm cases were identified from 154 sources. Patients were predominantly male (71.4%) and age ranged from 6 months to 89 years old. The commonest presentations were a neck mass and fever, but included haemorrhage, respiratory distress and neurological symptoms. Most aneurysms were located in the internal carotid artery (47.4%). Staphylococcus (23.4%) was the most commonly identified causative pathogen, followed by Mycobacterium tuberculosis (21.1%). Most appeared to become infected by direct local spread. Treatment strategies involved open surgical methods in 101 cases and an endovascular approach in 41 cases. In 4 cases, a hybrid method involving concurrent endovascular and open surgical management was undertaken. In five cases there was antibiotic treatment alone. In the open surgery treated group, the complication rate was 20.8% compared to 13.2% in the endovascular group. Mortality rate was 5.6%. Conclusion Direct local spread of a staphylococcus infection was the commonest cause. Endovascular management was associated with fewer complications than open surgical management and is recommended. Take-home message Carotid infected aneurysms are rare. They arise from direct spread of a staphylococcus or tuberculous infections. Endovascular management offers the best results.