REVIEW   

Italian Journal of Vascular and Endovascular Surgery 2017 June;24(2):63-9

DOI: 10.23736/S1824-4777.17.01295-5

Copyright © 2017 EDIZIONI MINERVA MEDICA

language: English

Vascular surgery intervention in Lemierre’s syndrome: case report and systematic review

Fabio J. PENCLE ¹ ✉, Polina L. LITVIN ¹, Vashti A. WAGNER ², Diana J. McPHEE ¹, Yilmaz GUNDUZ ¹, Alexander GART ¹

¹ Department of Surgery, Lincoln Medical and Mental Health Center, Bronx, NY, USA; ² Cornell University, Ithaca, NY, USA

INTRODUCTION: Lemierre’s syndrome classically presents with initial pharyngotonsillitis or peritonsillar abscess in young, previously healthy persons, manifesting with septic thrombophlebitis of the ipsilateral internal jugular vein. It has been described as a rare and pre-antibiotic era syndrome with an incidence rate of one in one million. There has, however, been a reported increase over the past two decades. The disease and syndrome presentation can easily be missed and thus a multidisciplinary approach is required for diagnosis and treatment. The purpose of this study is to review available literature to determine vascular surgery intervention in Lemierre’s syndrome.
EVIDENCE ACQUISITION: A systematic search of PubMed, Scopus, Cochrane and EMBASE databases up to August 2016 was conducted, according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines for literature presenting Lemierre’s Syndrome and vascular surgery intervention. Included studies were peer-reviewed articles or academic society publications. Papers with non-vascular surgery, non-English language, and non-adult cases were excluded. All papers meeting the final criteria were secondarily screened for analysis.
EVIDENCE SYNTHESIS: The search yielded 1242 unique articles, although only 7 studies met the final selection criteria. 10 of 31 cases required vascular surgery intervention. Average age was 29.7±4.4 years, with a M:F ratio of 7:3. Average time of symptoms prior to presentation was 6.4±1.7 days. Correlation analysis performed between variables of symptom days prior to presentation and white blood cells demonstrated R2=0.970 and P<0.001. Correlation analysis performed between variables of symptom days prior to presentation and days prior to surgery, demonstrated R2=0.286 and P=0.466. Resection and/or ligation of affected internal jugular vein was the most commonly performed surgical management.
CONCLUSIONS: Early consultation with establishment of a conclusive diagnosis with the aid of CT imaging yields optimal clinical outcome in Lemierre’s Syndrome. The authors conclude this rare syndrome presentation needs a multidisciplinary approach with vascular surgery after failed medical management.

KEY WORDS: Lemierre Syndrome - Vascular surgical procedures - Bacterial infections - Fusobacterium necrophorum