Resolution of an infectious pseudoaneurysm in a cervical petrous carotid vein bypass graft after covered stent placement: case report.
OBJECTIVE
Covered stenting of the carotid artery has been used to treat aneurysms and dissections. We describe a unique case of covered stenting in the setting of an infected psuedoaneurysm in a previously placed cervical-to-petrous vein bypass graft. Operating in an infected field and reopening a surgical wound at the craniocervical junction that had previously been exposed to penetrating trauma created substantial risks to open surgical repair. We therefore chose an endovascular strategy to repair this lesion.


METHODS
A 57-year-old diabetic man with a previously placed cervical-to-petrous vein bypass graft presented with chronic otitis media and acute hemorrhage from his right external auditory meatus. Evaluation revealed an infectious pseudoaneurysm of the vein graft at the skull base.


METHODS
The patient was treated with intravenous antibiotics and endovascular placement of an 8-mm x 25-mm polytetrafluoroethylene-covered stent across the pseudoaneurysm. Angiography obtained 8 months later confirmed successful obliteration of the lesion.


CONCLUSIONS
The patient's clinical outcome was excellent. Despite the active infection, covered stenting of the pseudoaneurysm was an effective treatment strategy, obviating the need for open debridement and graft revision.
Kim
Louis J
LJ
Division of Neurological Surgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona 85013, USA.
Albuquerque
Felipe C
FC
McDougall
Cameron G
CG
Spetzler
Robert F
RF
D017541:Aneurysm, False / Q000000981:diagnostic imaging / Q000382:microbiology / Q000601:surgery*; D002550:Cerebral Veins / Q000000981:diagnostic imaging / Q000382:microbiology / Q000601:surgery*; D002574:Cervical Vertebrae / Q000000981:diagnostic imaging / Q000601:surgery; D003937:Diagnosis, Differential; D006801:Humans; D008297:Male; D008875:Middle Aged; D010033:Otitis Media / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery*; D010579:Petrous Bone / Q000000981:diagnostic imaging / Q000601:surgery*; D011859:Radiography; D015607:Stents