[A surgically treated case of giant pseudoaneurysm arising as a complication following carotid endarterectomy].
We reported a case of giant pseudoaneurysm (PA) originating at the left extracranial internal carotid artery after carotid endarterectomy (CEA). A 60-year-old man underwent CEA for severe stenosis of the left internal carotid artery. A day after the operation, a left cervical painful and pulsatile mass beneath the operative scar was noticed. Soon after that, the patient showed dyspnea, and intratracheal intubation was carried out. 6 days after CEA, a painful swelling reoccurred. A left carotid angiogram visualized a 5 x 5 cm sized PA in the region of the left carotid bifurcation and demonstrated patency of the two major carotid branches. After a balloon catheter had been inserted and inflated at the carotid bifurcation, the patient underwent a second operation. The bleeding from arteriotomy was well controlled by the inflated balloon catheter at the carotid bifurcation. The continuous SURGILENE suture appeared to be disrupted and a saccular PA was found to have arisen from a defect on the lateral surface of the carotid bifurcation. The suture was completely removed and arteriotomy was closed with a continuous SURGILENE suture again and some single sutures were added. A PA arising as a complication following CEA is rare, but the possibility of PA after CEA should be considered in any patient presenting with a painful or/and pulsatile mass in the neck at any time interval following the operation. Angiography at the early post-op stage is necessary to rule out the various complications after CEA. To control the bleeding, the balloon catheter was thought to be very useful.
Hamada
M
M
Department of Neurosurgery, Tokyo Metropolitan Fuchu Hospital.
Mizutani
T
T
Miki
Y
Y
Kitahara
I
I
D017541:Aneurysm, False / Q000209:etiology* / Q000601:surgery*; D002343:Carotid Artery, Internal / Q000601:surgery; D016893:Carotid Stenosis / Q000601:surgery*; D002404:Catheterization; D016894:Endarterectomy, Carotid / Q000009:adverse effects*; D006801:Humans; D008297:Male; D008875:Middle Aged; D014654:Vascular Patency; D014656:Vascular Surgical Procedures / Q000379:methods