Hybrid Stent-Graft Repair of an Iatrogenic Complex Proximal Right Common Carotid Artery Injury

Background: Iatrogenic carotid trauma requires early diagnosis and adequate treatment. Classic open repair may be technically challenging if trauma is in base of the neck. We present a case of an iatrogenic carotid pseudoaneurysm treated with endovascular repair. Methods: An 87-year-old woman presented with a pulsatile neck mass 10 days after coronary artery bypass graft surgery. A computed tomographic angiogram showed a 1.6 x 1.0 x 2.0-cm pseudoaneurysm arising from the posterior wall of the proximal right common carotid artery. Endovascular management was considered, and a percutaneous angiogram demonstrated an arteriovenous fistula in addition to the pseudoaneurysm. Through a cervical cut-down, retrograde percutaneous access was obtained through the common carotid artery, which allowed easier access to the area of trauma owing to vessel tortuosity. Subsequently, a 5 mm x 2-cm Viabahn was deployed. The postdilation angiogram showed a significant endoleak that kept filling the pseudoaneurysm. A second 6 mm x 5-cm Viabahn was placed and successfully post-ilated with a 6 mm x 4-cm balloon. No endoleaks or fistulas were noted on the completion angiogram. Results: The patient remains asymptomatic after 15 months. Follow-up images showed thrombosis of pseudoaneurysm. Conclusion: Endovascular treatment with self-expanding stent-grafts and open cut-down access are excellent options to treat major vessel injuries at the base of the neck, where anatomy and cumbersome access make open surgery a more difficult option.