Stent-graft placement in a traumatic internal carotid-internal jugular fistula and pseudoaneurysm.
Traumatic arteriovenous fistulas following carotid artery injuries are rare. Treatment of carotid artery-to-jugular vein fistula requires direct closure of the fistula or occlusion of the carotid artery above and below the level of the fistula, by a surgical or endovascular approach. A 32-year-old man presented with a right-sided pulsatile neck swelling 2 days following a stab wound. Neck computed tomography demonstrated a vascular mass protruding into the anterior neck. Digital subtraction arteriography demonstrated a bilobular large internal carotid artery pseudoaneurysm just distal to its bifurcation. There was simultaneous opacification of a dilated left internal jugular vein indicating a high-flow internal carotid-internal jugular fistula. A balloon-expandable stent-graft was delivered and successfully positioned across the fistula. The arteriovenous fistula and pseudoaneurysm completely disappeared and the right internal carotid artery was well preserved. The stent-graft is a promising technology to obliterate fistulae and preserve the parent artery with relative safety.
Ahn
Jung Yong
JY
Department of Neurosurgery, Pundang CHA Hospital, Pochon CHA University, Yatap-dong, Pundang-gu, Sungnam, South Korea. jyahn@cha.ac.kr
Chung
Young Sun
YS
Lee
Byung Hee
BH
Choi
Sung Wook
SW
Kim
Ok Jun
OJ
D000328:Adult; D017541:Aneurysm, False / Q000209:etiology / Q000601:surgery*; D000792:Angiography / Q000379:methods; D001164:Arteriovenous Fistula / Q000209:etiology / Q000601:surgery*; D020216:Carotid-Cavernous Sinus Fistula / Q000209:etiology / Q000601:surgery*; D005500:Follow-Up Studies; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods; D008297:Male; D019919:Prosthesis Implantation / Q000379:methods*; D014951:Wounds, Stab / Q000150:complications