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February 1975

Mycotic Aneurysm of the Carotid Artery-Reply

Arch Surg. 1975;110(2):225. doi:10.1001/archsurg.1975.01360080091023


To the Editor.–Dr. Stoney implies that, "in light of information available today," autogenous vascular reconstruction of the carotid artery in the face of sepsis is appropriate. Experimentally, Foster and co-workers demonstrated that vascular reconstruction in a septic field is usually associated with disintegration of the vessel wall or disruption of the anastomosis.1 Recently, we treated a fourth patient in whom the wall of the common carotid artery and the internal jugular vein disintegrated in a field made septic by an esophageal fistula. This patient was also treated with proximal and distal ligation of the common carotid artery and has no neurological deficit. Autogenous reconstruction in all four patients would have required placement of a graft in the bed of an abscess cavity. The fate of such a graft is disintegration of the wall or rupture of the anastomosis, resulting in sudden exsanguinating hemorrhage or death from airway

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