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Adjunctive Endovascular Techniques in the Management of Postoperative Carotid Artery Pseudoaneurysms - Useful Armamentarium for Vascular Surgeons

Three Case Reports

Department of Surgery, University School of Medicine, Atlanta, GA

Michael J. Workman, MD

Department of Radiology, Emory University School of Medicine, Atlanta, GA

Zeev Loberman, MD

David L. Dawson, MD

Ruth L. Bush, MD

Department of Surgery, University School of Medicine, Atlanta, GA

Alan B. Lumsden, MD

Division of Vascular Surgery and Endovascular Therapy, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX

Peter H. Lin, MD

Division of Vascular Surgery and Endovascular Therapy, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX; plin{at}bcm.tmc.edu

Postoperative carotid artery pseudoaneurysms are rare. The traditional treatment of choice has been operative repair, which can present a significant technical challenge owing to the reoperative neck inflammation and potential cranial nerve injuries. The authors report 3 cases of postoperative carotid pseudoaneurysms that were successfully managed by use of various adjunctive endovascular techniques. The adjunctive endovascular maneuvers included the following: 1) endoluminal balloon placement for preoperative test occlusion and intraoperative proximal control to facilitate operative dissection in the first patient with a carotid pseudoaneurysm; 2) endoluminal stent-graft placement to exclude a large expanding carotid pseudoaneurysm in the second patient; and 3) endoluminal coil placement along with balloon occlusion to achieve complete hemostasis in the third patient, who presented with a hemorrhaging carotid pseudoaneurysm. Successful outcomes were achieved in all 3 patients by use of adjunctive endovascular techniques. These cases underscore the role of adjunctive endovascular treatment as an armamentarium for vascular surgeons in the treatment of complex carotid pseudoaneurysms.

Vascular and Endovascular Surgery, Vol. 37, No. 3, 207-212 (2003)
DOI: 10.1177/153857440303700308


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